Provider Demographics
NPI:1700111879
Name:GARCIA, JAVIER (LMT)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 LEE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4852
Mailing Address - Country:US
Mailing Address - Phone:239-369-2933
Mailing Address - Fax:888-577-7440
Practice Address - Street 1:1154 LEE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4852
Practice Address - Country:US
Practice Address - Phone:239-369-2933
Practice Address - Fax:888-577-7440
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist