Healthcare Provider Details

I. General information

NPI: 1326857111
Provider Name (Legal Business Name): EDGAR V GARCIA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N EGAN AVE
MADISON SD
57042-2139
US

IV. Provider business mailing address

6360 HARBOR WAY
WENTWORTH SD
57075-7318
US

V. Phone/Fax

Practice location:
  • Phone: 605-585-4419
  • Fax:
Mailing address:
  • Phone: 605-585-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT12139
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: