Provider Demographics
NPI:1750679668
Name:GARCIA, ANGELA (LMP, PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMP, PTA
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP, PTA
Mailing Address - Street 1:220 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1526
Mailing Address - Country:US
Mailing Address - Phone:509-865-5650
Mailing Address - Fax:509-865-5633
Practice Address - Street 1:220 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1526
Practice Address - Country:US
Practice Address - Phone:509-865-5650
Practice Address - Fax:509-865-5633
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING225200000X
WAMA18059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant