Active NPI
Edward J Galarza Jr., BS PT
- Physical Therapist
- Grayslake, IL
National Provider Identifier
1093804833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 70011087
- Practice address
- 1585 Lupine CT
Grayslake, IL 60030-3512 - Phone
- (773) 294-0647
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 70011087 | IL | Primary |
Addresses
Primary practice location
1585 Lupine CT
Grayslake, IL 60030-3512
Mailing address
1585 Lupine CT
Grayslake, IL 60030-3512
Phone (773) 294-0647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220509002476 | IL | Practitioner - Physical Therapist in Private Practice | 7618354838 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70011087 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346716800000",
"number": "1093804833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1585 LUPINE CT",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600303512",
"telephone_number": "773-294-0647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1585 LUPINE CT",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600303512",
"telephone_number": "773-294-0647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALARZA",
"first_name": "EDWARD",
"middle_name": "J",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "BS PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2012-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "70011087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayslake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.