MEDICARE: VALERIA CAROLINA GALVAN GODINES 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	1391760	TX

General Provider Information

NPI Number	:	1730920240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIA CAROLINA GALVAN GODINES PT, DPT

Provider Business Mailing Address
First Line	:	6509 PLAZA PKWY APT 212
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2421
Country	:	US
Telephone Number	:	956-639-5046
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 HERITAGE TRACE PKWY STE 220
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5309
Country	:	US
Telephone Number	:	682-325-3015
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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