Provider Demographics
NPI:1730258724
Name:GALVAN, ELIAS LOPEZ JR (PT)
Entity type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:LOPEZ
Last Name:GALVAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3109 JONES RD
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1334
Mailing Address - Country:US
Mailing Address - Phone:512-671-0726
Mailing Address - Fax:512-892-7183
Practice Address - Street 1:1825 FORTVIEW RD
Practice Address - Street 2:SUITE 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7657
Practice Address - Country:US
Practice Address - Phone:512-892-5250
Practice Address - Fax:512-892-7183
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11482792251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX870T83OtherBCBS
TX870T83OtherBCBS