Provider Demographics
NPI:1336273077
Name:GALLIEN, RON (PT OCS)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:GALLIEN
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4617
Mailing Address - Country:US
Mailing Address - Phone:575-437-1967
Mailing Address - Fax:575-437-3969
Practice Address - Street 1:1809 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4617
Practice Address - Country:US
Practice Address - Phone:505-437-1967
Practice Address - Fax:505-437-3969
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM400521174Medicare ID - Type Unspecified
NM40052117Medicare UPIN
400521174Medicare UPIN