Provider Demographics
NPI:1740455062
Name:GALLUP, ALISON ELENA (PT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ELENA
Last Name:GALLUP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:E
Other - Last Name:RAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11410 JOLLYVILLE RD
Mailing Address - Street 2:STE 1101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4093
Mailing Address - Country:US
Mailing Address - Phone:512-231-1444
Mailing Address - Fax:
Practice Address - Street 1:3018 E COLORADO BLVD # 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3840
Practice Address - Country:US
Practice Address - Phone:626-449-3900
Practice Address - Fax:626-449-4505
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358202251X0800X
TX1178240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1178240OtherPHYSICAL THERAPY LICENSE NUMBER