Provider Demographics
NPI:1952094153
Name:GALLARDO, ANGEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-6763
Mailing Address - Country:US
Mailing Address - Phone:682-557-6125
Mailing Address - Fax:
Practice Address - Street 1:811 NE ALSBURY BLVD STE 800
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2664
Practice Address - Country:US
Practice Address - Phone:817-293-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3131172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist