Provider Demographics
NPI:1386475622
Name:GARCIA, GAVIN (DPT)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PIERRE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2531
Mailing Address - Country:US
Mailing Address - Phone:909-468-0438
Mailing Address - Fax:909-468-0438
Practice Address - Street 1:138 PIERRE RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2531
Practice Address - Country:US
Practice Address - Phone:909-468-0438
Practice Address - Fax:909-468-0438
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist