Provider Demographics
NPI:1417431321
Name:GALLEGOS, LUIS EDUARDO (LPTA)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:EDUARDO
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 NIKKIE LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-8342
Mailing Address - Country:US
Mailing Address - Phone:956-402-0072
Mailing Address - Fax:
Practice Address - Street 1:1700 W GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7305
Practice Address - Country:US
Practice Address - Phone:956-583-8876
Practice Address - Fax:956-580-2356
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant