Provider Demographics
NPI:1598144180
Name:GARCIA, AWILDA ALLEY (LMT)
Entity Type:Individual
Prefix:
First Name:AWILDA
Middle Name:ALLEY
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALLEY
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:606 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1206
Mailing Address - Country:US
Mailing Address - Phone:978-641-9006
Mailing Address - Fax:978-521-2678
Practice Address - Street 1:606 BROADWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-1206
Practice Address - Country:US
Practice Address - Phone:978-641-9006
Practice Address - Fax:978-521-2678
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3344225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist