Provider Demographics
NPI:1245416833
Name:GARCIA, JOHN ERIC (LMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
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 1:1515 GOLF COURSE RD SE STE 103
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2586
Mailing Address - Country:US
Mailing Address - Phone:505-892-6307
Mailing Address - Fax:505-892-0346
Practice Address - Street 1:1515 GOLF COURSE RD SE STE 103
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2586
Practice Address - Country:US
Practice Address - Phone:505-892-6307
Practice Address - Fax:505-892-0346
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172M00000X, 174400000X, 225400000X
NM4612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty