Provider Demographics
NPI:1023164514
Name:GALLEGOS, CLAUDETTE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
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 1:2114 E MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-1005
Mailing Address - Country:US
Mailing Address - Phone:956-333-6350
Mailing Address - Fax:
Practice Address - Street 1:2114 E MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-1005
Practice Address - Country:US
Practice Address - Phone:956-333-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1323257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2020822OtherLICENSE