Provider Demographics
NPI:1528602620
Name:DE LA GARZA, ANNA EMILIA (PT)
Entity Type:Individual
Prefix:
First Name:ANNA EMILIA
Middle Name:
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 PINEGATE DR APT 329
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3975
Mailing Address - Country:US
Mailing Address - Phone:956-266-5630
Mailing Address - Fax:
Practice Address - Street 1:17580 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4972
Practice Address - Country:US
Practice Address - Phone:936-267-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1324676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty