Provider Demographics
NPI:1548200645
Name:GARZA, MICHELLE B (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:B
Last Name:GARZA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14545 W. GRAND AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-7279
Mailing Address - Country:US
Mailing Address - Phone:623-544-0300
Mailing Address - Fax:623-544-0239
Practice Address - Street 1:14545 W. GRAND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-7279
Practice Address - Country:US
Practice Address - Phone:623-544-0300
Practice Address - Fax:623-544-0239
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ932815Medicaid
AZZ101210Medicare PIN
AZP00187855Medicare PIN
AZ932815Medicaid