Provider Demographics
NPI:1780665182
Name:GARCIA, LOWEL MANTO X (PT)
Entity Type:Individual
Prefix:MR
First Name:LOWEL
Middle Name:MANTO
Last Name:GARCIA
Suffix:X
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 1:603 N BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1619
Mailing Address - Country:US
Mailing Address - Phone:856-845-4488
Mailing Address - Fax:856-853-5256
Practice Address - Street 1:603 N BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1619
Practice Address - Country:US
Practice Address - Phone:856-845-4488
Practice Address - Fax:856-853-5256
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA009458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist