Provider Demographics
NPI:1245330034
Name:GARCIA, LUCIANO (PT)
Entity type:Individual
Prefix:
First Name:LUCIANO
Middle Name:
Last Name:GARCIA
Suffix:
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 1:10223 W BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:713-436-3900
Mailing Address - Fax:713-436-3904
Practice Address - Street 1:10223 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7881
Practice Address - Country:US
Practice Address - Phone:713-436-3900
Practice Address - Fax:713-436-3904
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1132363OtherLICENSE#