Healthcare Provider Details

I. General information

NPI: 1437502036
Provider Name (Legal Business Name): STEPHANIE GARZA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 KERN WAY STE 102
YAKIMA WA
98902-7804
US

IV. Provider business mailing address

3901 KERN WAY STE 102
YAKIMA WA
98902-7804
US

V. Phone/Fax

Practice location:
  • Phone: 509-895-7449
  • Fax:
Mailing address:
  • Phone: 509-895-7449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60038142
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: