Active NPI
Ian Ricardo Gallegos, PTA
- Physical Therapy Assistant
- Roswell, NM
National Provider Identifier
1649639931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1601
- Practice address
- 3200 Mission Arch Dr
Roswell, NM 88201-8307 - Phone
- (575) 624-2583
- Fax
- (575) 623-8949
- NPI assigned
- Feb 16, 2016
- 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 Therapy Assistant | 225200000X | 1601 | NM | Primary |
Addresses
Primary practice location
3200 Mission Arch Dr
Roswell, NM 88201-8307
Mailing address
3200 Mission Arch Dr
Roswell, NM 88201-8307
Phone (575) 624-2583
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601 | NM | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455580800000",
"number": "1649639931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 MISSION ARCH DR",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882018307",
"telephone_number": "575-624-2583",
"fax_number": "575-623-8949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MISSION ARCH DR",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882018307",
"telephone_number": "575-624-2583",
"fax_number": "575-623-8949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLEGOS",
"first_name": "IAN",
"middle_name": "RICARDO",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-16",
"last_updated": "2016-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NM",
"license": "1601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.