Provider Demographics
NPI:1871888941
Name:GARZA, JACOB (PT)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7269
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:7939 PAT BOOKER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2753
Practice Address - Country:US
Practice Address - Phone:210-660-2345
Practice Address - Fax:210-446-1442
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1206531225100000X
TX3110301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
456890Medicare Oscar/Certification
TX0031DGOtherBLUE CROSS BLUE SHIELD
TX0944746-02Medicaid