Provider Demographics
NPI:1225513880
Name:GARCIA, LOUIS RANESES (PT)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:RANESES
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26522 CLYDESDALE LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3335
Mailing Address - Country:US
Mailing Address - Phone:626-510-4678
Mailing Address - Fax:
Practice Address - Street 1:15315 1ST AVE NE # 5
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-5004
Practice Address - Country:US
Practice Address - Phone:425-413-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60769102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist