Healthcare Provider Details

I. General information

NPI: 1295934420
Provider Name (Legal Business Name): MA ANGELA S GARNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N MAIN STREET #501
COTULLA TX
78014
US

IV. Provider business mailing address

2619 SAN ISIDRO PKWY #501
LAREDO TX
78045-6570
US

V. Phone/Fax

Practice location:
  • Phone: 956-712-0770
  • Fax: 956-391-1707
Mailing address:
  • Phone: 956-638-3559
  • Fax: 956-391-1707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1068369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: