Provider Demographics
NPI:1093690935
Name:GARCIA, LAUREN SUSANNE (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUSANNE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 CASA GRANDE CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-5101
Mailing Address - Country:US
Mailing Address - Phone:209-484-9130
Mailing Address - Fax:
Practice Address - Street 1:6086 COMEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2204
Practice Address - Country:US
Practice Address - Phone:310-915-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist