Provider Demographics
NPI:1902628878
Name:GARZA, NATALIE ANITA (LMT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANITA
Last Name:GARZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:LAKE NORDEN
Mailing Address - State:SD
Mailing Address - Zip Code:57248-0252
Mailing Address - Country:US
Mailing Address - Phone:605-785-3900
Mailing Address - Fax:
Practice Address - Street 1:505 MAIN AVE # 252
Practice Address - Street 2:
Practice Address - City:LAKE NORDEN
Practice Address - State:SD
Practice Address - Zip Code:57248-0252
Practice Address - Country:US
Practice Address - Phone:605-785-3900
Practice Address - Fax:605-785-3908
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT12113225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist