Provider Demographics
NPI:1285212811
Name:GARCIA, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 TELEPHONE RD STE 903
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5663
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:
Practice Address - Street 1:20 COMMONS CORNER WAY UNIT 12-A
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-2291
Practice Address - Country:US
Practice Address - Phone:401-726-7100
Practice Address - Fax:401-213-8380
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03558225100000X
CA299904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist