Healthcare Provider Details

I. General information

NPI: 1588086409
Provider Name (Legal Business Name): CHRISTOPHER ANGEL GARCIA PT, DPT, SCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 CANARIOS CT SUITE 110
CHULA VISTA CA
91910-7877
US

IV. Provider business mailing address

885 CANARIOS CT SUITE 110
CHULA VISTA CA
91910-7877
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-5102
  • Fax:
Mailing address:
  • Phone: 619-656-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34816
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number34816
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number34816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: