Provider Demographics
NPI:1770754442
Name:GARCIA, SUSEL (PT)
Entity type:Individual
Prefix:
First Name:SUSEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4224
Mailing Address - Country:US
Mailing Address - Phone:850-236-7497
Mailing Address - Fax:850-236-7499
Practice Address - Street 1:3210 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4224
Practice Address - Country:US
Practice Address - Phone:850-236-7497
Practice Address - Fax:850-236-7499
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386647683Medicare PIN