Provider Demographics
NPI:1740760362
Name:GARZA, STEPHANIE LYNN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:GARZA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8694 FM 1329
Mailing Address - Street 2:
Mailing Address - City:CONCEPCION
Mailing Address - State:TX
Mailing Address - Zip Code:78349-3528
Mailing Address - Country:US
Mailing Address - Phone:361-228-4833
Mailing Address - Fax:
Practice Address - Street 1:3130 S BRAHMA BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7257
Practice Address - Country:US
Practice Address - Phone:361-592-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2129777208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation