Provider Demographics
NPI:1588662035
Name:GARCIA, JAMIE (MPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11380 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE B-109
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3474
Mailing Address - Country:US
Mailing Address - Phone:561-803-7761
Mailing Address - Fax:561-803-7762
Practice Address - Street 1:11380 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE B-109
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3474
Practice Address - Country:US
Practice Address - Phone:561-803-7761
Practice Address - Fax:561-803-7762
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU17642Medicare ID - Type Unspecified