Provider Demographics
NPI:1679824015
Name:GARCIA, MARTHA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10737 S AVENUE F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6709
Mailing Address - Country:US
Mailing Address - Phone:773-375-4303
Mailing Address - Fax:
Practice Address - Street 1:1551 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5440
Practice Address - Country:US
Practice Address - Phone:708-862-5500
Practice Address - Fax:708-862-2211
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist