Provider Demographics
NPI:1184047151
Name:GARCIA, JESUS MANUEL
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:MANUEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:770-749-0250
Mailing Address - Fax:770-749-0086
Practice Address - Street 1:1566 ROME HWY
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-4403
Practice Address - Country:US
Practice Address - Phone:770-749-0250
Practice Address - Fax:770-749-0086
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9684225100000X
SC7192225100000X
MO2013022021225100000X
GAPT015113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist