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General NPI Number Information
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NPI Number | 1326857111
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Entity Type | Individual
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Provider Name | EDGAR V GARCIA LMT
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Gender | Male
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 227 N EGAN AVE
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City | MADISON
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State | SD
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Zip | 57042-2139
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Country | US
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Telephone | 605-585-4419
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Fax |
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Provider Business Mailing Address
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Address Line | 6360 HARBOR WAY
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City | WENTWORTH
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State | SD
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Zip | 57075-7318
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Country | US
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Telephone | 605-585-4419
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT12139
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License Number State | SD
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