Provider Demographics
NPI:1831307180
Name:DE LA GARZA, BERTHA (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 SANDEFER ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 HICKORY ST
Practice Address - Street 2:ATHLETIC DEPARTMENT BOX 16185
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2345
Practice Address - Country:US
Practice Address - Phone:325-670-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT20672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer