Provider Demographics
NPI:1447961867
Name:GARCIA, KATHRYN MAE (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN MAE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN MAE
Other - Middle Name:
Other - Last Name:ROA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3150 MACHADO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-1630
Mailing Address - Country:US
Mailing Address - Phone:408-828-5063
Mailing Address - Fax:
Practice Address - Street 1:3150 MACHADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-1630
Practice Address - Country:US
Practice Address - Phone:408-828-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist