MEDICARE: ROBERT CARLOS GALLEGOS PT

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	582	NM

General Provider Information

NPI Number	:	1316094790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CARLOS GALLEGOS PT

Provider Business Mailing Address
First Line	:	4608 CARL HATCH PL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5331
Country	:	US
Telephone Number	:	505-727-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 MCMAHON BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5090
Country	:	US
Telephone Number	:	505-898-6082
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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