Healthcare Provider Details

I. General information

NPI: 1245416833
Provider Name (Legal Business Name): JOHN ERIC GARCIA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 GOLF COURSE RD SE STE 103
RIO RANCHO NM
87124-2586
US

IV. Provider business mailing address

1515 GOLF COURSE RD SE STE 103
RIO RANCHO NM
87124-2586
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-6307
  • Fax: 505-892-0346
Mailing address:
  • Phone: 505-892-6307
  • Fax: 505-892-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4612
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: