Provider Demographics
NPI:1063683498
Name:GARCIA, KRISTINA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1309
Mailing Address - Country:US
Mailing Address - Phone:410-686-2270
Mailing Address - Fax:410-686-5447
Practice Address - Street 1:2021A EMMORTON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8962
Practice Address - Country:US
Practice Address - Phone:410-515-0006
Practice Address - Fax:410-515-0027
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2749225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant