Provider Demographics
NPI:1447305214
Name:GARCIA, THERESA REGINA (PTA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:REGINA
Last Name:GARCIA
Suffix:
Gender:F
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:PO BOX 52431
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79710-2431
Mailing Address - Country:US
Mailing Address - Phone:432-699-1036
Mailing Address - Fax:
Practice Address - Street 1:501 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5818
Practice Address - Country:US
Practice Address - Phone:432-570-7587
Practice Address - Fax:432-620-6675
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant