Basic Information
| Provider Information | |||||||||
| NPI: | 1861957367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLEGOS | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6501 HARRIS PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761326102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173709891 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2445 W OAK ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762014326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403206030 | ||||||||
| FaxNumber: | 9403203113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2019 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1314730 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.