Provider Demographics
NPI:1730285826
Name:GARCIA, JESSE (PT)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S WASHINGTON ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2608
Mailing Address - Country:US
Mailing Address - Phone:509-242-6002
Mailing Address - Fax:509-624-5061
Practice Address - Street 1:507 S WASHINGTON ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2608
Practice Address - Country:US
Practice Address - Phone:509-242-6002
Practice Address - Fax:509-624-5061
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT6879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115090Medicaid
WA8341166Medicaid
WA8341166Medicaid