1417329889 NPI number — MS. MARIA GRACIA GARCIA RODRIGUEZ PT, DPT

Table of content: MS. MARIA GRACIA GARCIA RODRIGUEZ PT, DPT (NPI 1417329889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417329889 NPI number — MS. MARIA GRACIA GARCIA RODRIGUEZ PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA RODRIGUEZ
Provider First Name:
MARIA
Provider Middle Name:
GRACIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417329889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 OSIGIAN BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WARNER ROBINS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31088-8968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-333-3075
Provider Business Mailing Address Fax Number:
478-333-3484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 OSIGIAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WARNER ROBINS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31088-8968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-333-3075
Provider Business Practice Location Address Fax Number:
478-333-3484
Provider Enumeration Date:
10/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT012096 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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