Provider Demographics
NPI:1992834691
Name:GARCIA, FRED JR (PT)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:GARCIA
Suffix:JR
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 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-5110
Mailing Address - Country:US
Mailing Address - Phone:325-754-4381
Mailing Address - Fax:325-754-4415
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567-5110
Practice Address - Country:US
Practice Address - Phone:325-754-4381
Practice Address - Fax:325-754-4415
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650555Medicare ID - Type Unspecified
TXS94390Medicare UPIN