Provider Demographics
NPI:1659554483
Name:GARZA, GRACIELA M (LPT)
Entity Type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:M
Last Name:GARZA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 E FROST ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-1528
Mailing Address - Country:US
Mailing Address - Phone:956-857-5900
Mailing Address - Fax:956-718-2354
Practice Address - Street 1:3301 E FROST ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-1528
Practice Address - Country:US
Practice Address - Phone:956-857-5900
Practice Address - Fax:956-718-2354
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679506Medicare Oscar/Certification