Provider Demographics
NPI:1285231829
Name:GARCIA, RAYMUND LAURENCE (RPT)
Entity Type:Individual
Prefix:MR
First Name:RAYMUND
Middle Name:LAURENCE
Last Name:GARCIA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:RAYMUND LAURENCE
Other - Middle Name:DE VERA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:9026 LA CROSSE AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9026 LA CROSSE AVE APT 2A
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1740
Practice Address - Country:US
Practice Address - Phone:312-785-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist