MEDICARE: SAMANTHA CHARLES GALLEGO PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1346473	TX

General Provider Information

NPI Number	:	1184292120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA CHARLES GALLEGO PT, DPT

Provider Business Mailing Address
First Line	:	1508 WOODARD ST # A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1621
Country	:	US
Telephone Number	:	832-971-3679
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 N SAM HOUSTON PKWY E STE 199
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3325
Country	:	US
Telephone Number	:	281-822-0808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	04/09/2026

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