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General NPI Number Information
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NPI Number | 1104335843
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Entity Type | Individual
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Provider Name | IVAN PEDRO GARCIA ATC, LAT, CES
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Gender | Male
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 2200 DENNISON ST
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City | DALLAS
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State | TX
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Zip | 75212-2460
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Country | US
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Telephone | 972-502-2718
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Fax |
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Provider Business Mailing Address
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Address Line | 3640 AVENUE J
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City | FORT WORTH
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State | TX
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Zip | 76105-3237
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Country | US
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Telephone | 817-965-6287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5961
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License Number State | TX
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