Provider Demographics
NPI:1679556047
Name:JOHNSON-GALVEZ, TEGAN E (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:TEGAN
Middle Name:E
Last Name:JOHNSON-GALVEZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:TEGAN
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:246 SOBRANTE WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-4807
Mailing Address - Country:US
Mailing Address - Phone:408-733-3670
Mailing Address - Fax:408-245-7968
Practice Address - Street 1:246 SOBRANTE WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-4807
Practice Address - Country:US
Practice Address - Phone:408-733-3670
Practice Address - Fax:408-245-7968
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT299530Medicare PIN
CACF359ZMedicare PIN