Provider Demographics
NPI:1942514823
Name:GALLEGOS, LISA M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 E RAINBOW BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2971
Mailing Address - Country:US
Mailing Address - Phone:719-221-6940
Mailing Address - Fax:
Practice Address - Street 1:7620 W HWY 50
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9344
Practice Address - Country:US
Practice Address - Phone:719-539-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4836172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist