Provider Demographics
NPI:1093298416
Name:GARCIA, JUAN LUIS (PTA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:LUIS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-1823
Mailing Address - Country:US
Mailing Address - Phone:806-200-1027
Mailing Address - Fax:
Practice Address - Street 1:1111 AVENUE P
Practice Address - Street 2:
Practice Address - City:RALLS
Practice Address - State:TX
Practice Address - Zip Code:79357-3502
Practice Address - Country:US
Practice Address - Phone:806-253-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2129801225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant