Provider Demographics
NPI:1881335339
Name:GALLEGOS, ROXANNE PRISCILLA (PT)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:PRISCILLA
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5345
Mailing Address - Country:US
Mailing Address - Phone:210-792-8206
Mailing Address - Fax:
Practice Address - Street 1:1625 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5345
Practice Address - Country:US
Practice Address - Phone:210-792-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist