Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 20965 | FL |
NPI | 1043262702 |
---|---|
Provider Name | Omar Alberto Garcia |
First Address | Port Charlotte, FL 33948-1034 |
Second Address | Port Charlotte, FL 33948-1034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y911K | BC/BS (01) | FL |