Provider Demographics
NPI:1558591529
Name:GALLEGOS, ALEGRE (MPT)
Entity Type:Individual
Prefix:
First Name:ALEGRE
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 HARPER DR NE
Mailing Address - Street 2:STE 110
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3573
Mailing Address - Country:US
Mailing Address - Phone:505-823-9166
Mailing Address - Fax:505-858-0030
Practice Address - Street 1:5700 HARPER DR NE
Practice Address - Street 2:STE 110
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3573
Practice Address - Country:US
Practice Address - Phone:505-823-9166
Practice Address - Fax:505-858-0030
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist