Provider Demographics
NPI:1164874905
Name:GARCIA, JUAN MANUEL (LMT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2475
Mailing Address - Country:US
Mailing Address - Phone:956-432-3496
Mailing Address - Fax:
Practice Address - Street 1:4305 N 10TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3051
Practice Address - Country:US
Practice Address - Phone:956-432-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT111315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist