Provider Demographics
NPI:1831474667
Name:GARZA, GERARDO (PTA)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S BICENTENNIAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-7016
Mailing Address - Country:US
Mailing Address - Phone:956-688-6141
Mailing Address - Fax:
Practice Address - Street 1:220 S BICENTENNIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-7016
Practice Address - Country:US
Practice Address - Phone:956-688-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2045854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant