Provider Demographics
NPI:1861884280
Name:GALVEZ, RANDIMIEL (PT)
Entity type:Individual
Prefix:
First Name:RANDIMIEL
Middle Name:
Last Name:GALVEZ
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 1:3717 EMMETT HUTTO BLVD
Mailing Address - Street 2:APT 217
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1781
Mailing Address - Country:US
Mailing Address - Phone:815-718-9280
Mailing Address - Fax:
Practice Address - Street 1:3717 EMMETT HUTTO BLVD
Practice Address - Street 2:APT 217
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1781
Practice Address - Country:US
Practice Address - Phone:815-718-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1217890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist