Healthcare Provider Details

I. General information

NPI: 1194922096
Provider Name (Legal Business Name): PEDRO MANOLIN GARCIA JR. PHYSICAL THER ASST0
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N MAIN ST
SOUTH YARMOUTH MA
02664-2083
US

IV. Provider business mailing address

265 N MAIN ST
SOUTH YARMOUTH MA
02664-2083
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-3514
  • Fax: 508-394-9360
Mailing address:
  • Phone: 508-394-3514
  • Fax: 508-394-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 00506
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9445
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: