Provider Demographics
NPI:1205095411
Name:GALLEGOS, IRMA TRISHA (PT)
Entity type:Individual
Prefix:MISS
First Name:IRMA TRISHA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6533
Mailing Address - Country:US
Mailing Address - Phone:718-551-0200
Mailing Address - Fax:718-261-2896
Practice Address - Street 1:11615 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6533
Practice Address - Country:US
Practice Address - Phone:718-551-0200
Practice Address - Fax:718-261-2896
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist