Provider Demographics
NPI:1962903146
Name:GALLEGOS, BENJAMIN E (PT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:E
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 W I 20 STE 218
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-7603
Mailing Address - Country:US
Mailing Address - Phone:682-238-3243
Mailing Address - Fax:817-549-0106
Practice Address - Street 1:2340 W I 20 STE 218
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-7603
Practice Address - Country:US
Practice Address - Phone:682-238-3243
Practice Address - Fax:817-549-0106
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist