Provider Demographics
NPI:1821579749
Name:GARZA, RAYMUNDO (PTA)
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-8787
Mailing Address - Country:US
Mailing Address - Phone:956-317-1282
Mailing Address - Fax:
Practice Address - Street 1:5346 EAST HIGHWAY 83 UNIT 2 BUILDING A
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-7858
Practice Address - Country:US
Practice Address - Phone:956-317-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2073403225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty