Healthcare Provider Details

I. General information

NPI: 1881842607
Provider Name (Legal Business Name): FAUSTINO H. GARCIA JR. PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JUN H. GARCIA PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MOUNT PELIA RD
MARTIN TN
38237-3812
US

IV. Provider business mailing address

117 ARCHTREE LN
MARTIN TN
38237-8127
US

V. Phone/Fax

Practice location:
  • Phone: 731-587-4231
  • Fax: 731-587-6716
Mailing address:
  • Phone: 731-587-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number3034
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: