Provider Demographics
NPI:1043459209
Name:GARCIA, AUDREY R (PT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:R
Last Name:GARCIA
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 1:1801 W QUEEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3001
Mailing Address - Country:US
Mailing Address - Phone:480-812-1800
Mailing Address - Fax:480-812-1839
Practice Address - Street 1:1801 W QUEEN CREEK RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3001
Practice Address - Country:US
Practice Address - Phone:480-812-1800
Practice Address - Fax:480-812-1839
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6555208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6555OtherSTATE LICENCE