Provider Demographics
NPI:1740886118
Name:GARCIA, ANDRES VICENTE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:VICENTE
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 FLINTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8696
Mailing Address - Country:US
Mailing Address - Phone:850-512-7149
Mailing Address - Fax:
Practice Address - Street 1:8199 NAVARRE PKWY STE 12A
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6941
Practice Address - Country:US
Practice Address - Phone:850-939-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist