Provider Demographics
NPI:1225184005
Name:GARCIA, AGNES (PT)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 OCEANVIEW AVE 1ST FL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-934-0322
Mailing Address - Fax:718-336-0994
Practice Address - Street 1:719 OCEAN VIEW AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6317
Practice Address - Country:US
Practice Address - Phone:718-934-0322
Practice Address - Fax:718-336-0994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023517-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20G51Medicare ID - Type UnspecifiedPHYSICAL THERAPIST