Provider Demographics
NPI:1942693064
Name:GARZA, MAIELA RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:MAIELA
Middle Name:RENEE
Last Name:GARZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAIELA
Other - Middle Name:RENEE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 S D ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1854
Mailing Address - Country:US
Mailing Address - Phone:956-686-2242
Mailing Address - Fax:956-686-3515
Practice Address - Street 1:2001 S D ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1854
Practice Address - Country:US
Practice Address - Phone:956-686-2242
Practice Address - Fax:956-686-3515
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1252101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3490484Medicaid