MEDICARE: TEDDY GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-377333	FL

General Provider Information

NPI Number	:	1578390571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEDDY GARCIA

Provider Business Mailing Address
First Line	:	13581 EAGLE RIDGE DR APT 1426
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-6814
Country	:	US
Telephone Number	:	239-895-4058
Fax Number	:

Provider Business Practice Location Address
First Line	:	28410 BONITA CROSSINGS BLVD UNIT 150
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-3217
Country	:	US
Telephone Number	:	239-451-7163
Fax Number	:	239-310-2045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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Directions to “ TEDDY GARCIA ” Practice Location

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