Provider Demographics
NPI:1629166731
Name:GARCIA, SAMUEL M (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 SOARES PL
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-3859
Mailing Address - Country:US
Mailing Address - Phone:209-869-3160
Mailing Address - Fax:
Practice Address - Street 1:3215 N CALIFORNIA ST STE 4
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3433
Practice Address - Country:US
Practice Address - Phone:209-464-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist