Provider Demographics
NPI:1740989698
Name:GARZA, JUDITH (LAT, SIS,CCS-P)
Entity type:Individual
Prefix:MR
First Name:JUDITH
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:LAT, SIS,CCS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8507
Mailing Address - Country:US
Mailing Address - Phone:956-635-9673
Mailing Address - Fax:
Practice Address - Street 1:113 SALEM DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8507
Practice Address - Country:US
Practice Address - Phone:956-635-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT85462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty