Provider Demographics
NPI:1225859119
Name:GARCIA-MORENO, SANDRA ALICE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ALICE
Last Name:GARCIA-MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 28051 BOX 27
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-8051
Mailing Address - Country:US
Mailing Address - Phone:314-590-3821
Mailing Address - Fax:
Practice Address - Street 1:UNIT 28051 BOX 27
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-8051
Practice Address - Country:US
Practice Address - Phone:314-590-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5482225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant