Provider Demographics
NPI:1528000460
Name:VALLES, GLORIA E
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:E
Last Name:VALLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 BABCOCK RD
Mailing Address - Street 2:710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6028
Mailing Address - Country:US
Mailing Address - Phone:210-396-5270
Mailing Address - Fax:210-396-5271
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:710
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-396-5270
Practice Address - Fax:210-396-5271
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0548Medicare PIN