Provider Demographics
NPI:1073105854
Name:GARCIA, LESLIE E (DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N. MALINCHE AVE.
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3354
Mailing Address - Country:US
Mailing Address - Phone:956-722-2431
Mailing Address - Fax:956-725-2704
Practice Address - Street 1:3406 S MILMO AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-7340
Practice Address - Country:US
Practice Address - Phone:956-489-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1336879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist