Provider Demographics
NPI:1245685254
Name:GALLUCCI, ANDREW (PHD, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GALLUCCI
Suffix:
Gender:M
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N CEDAR RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5685
Mailing Address - Country:US
Mailing Address - Phone:254-400-0559
Mailing Address - Fax:
Practice Address - Street 1:1 BEAR PL UNIT 97313
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76798-7313
Practice Address - Country:US
Practice Address - Phone:254-710-4026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer