Provider Demographics
NPI:1710077227
Name:GARVIN, REBECA LYN (PT)
Entity Type:Individual
Prefix:MISS
First Name:REBECA
Middle Name:LYN
Last Name:GARVIN
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:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90733-0349
Mailing Address - Country:US
Mailing Address - Phone:310-548-0104
Mailing Address - Fax:
Practice Address - Street 1:28924 S WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0885
Practice Address - Country:US
Practice Address - Phone:310-548-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14553OtherMEDICARE GROUP NUMBER
CAWPT32851BMedicare PIN