Provider Demographics
NPI:1659390987
Name:GARCIA, LAURA E (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2010
Mailing Address - Country:US
Mailing Address - Phone:510-526-2353
Mailing Address - Fax:510-526-2022
Practice Address - Street 1:948 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2010
Practice Address - Country:US
Practice Address - Phone:510-526-2353
Practice Address - Fax:510-526-2022
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT178900Medicare ID - Type Unspecified