Provider Demographics
NPI:1477535623
Name:GARCIA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GARCIA PHYSICAL THERAPY, LLC
Other - Org Name:MARIA SYLVIA GARCIA
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-442-1234
Mailing Address - Street 1:1526 IDYLWILD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2237
Mailing Address - Country:US
Mailing Address - Phone:928-442-1234
Mailing Address - Fax:928-442-1351
Practice Address - Street 1:2285 THUMB BUTTE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7551
Practice Address - Country:US
Practice Address - Phone:928-442-1234
Practice Address - Fax:928-442-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105416Medicare PIN