Provider Demographics
NPI:1386831923
Name:GARCIA, CISCO RAY (LPTA, LAT)
Entity Type:Individual
Prefix:MR
First Name:CISCO
Middle Name:RAY
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LPTA, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 SUL ROSS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5305
Mailing Address - Country:US
Mailing Address - Phone:325-947-0966
Mailing Address - Fax:
Practice Address - Street 1:2167 SUL ROSS ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5305
Practice Address - Country:US
Practice Address - Phone:325-947-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2043974225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant