Provider Demographics
NPI:1598371783
Name:GARZA-WILT, LAURA J (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:GARZA-WILT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5814 KATELYN MARY PL UNIT 304
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-5445
Mailing Address - Country:US
Mailing Address - Phone:703-405-5095
Mailing Address - Fax:
Practice Address - Street 1:5814 KATELYN MARY PL UNIT 304
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-5445
Practice Address - Country:US
Practice Address - Phone:703-405-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2248225700000X
VA0019010887225700000X
FLMA100735225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist