MEDICARE: MS. MARIA LOURDES GARCIA SALES PT

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	225100000X	Physical Therapist	21719	MA

General Provider Information

NPI Number	:	1801276886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA LOURDES GARCIA SALES PT

Provider Business Mailing Address
First Line	:	1359 E SAMPLE RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6278
Country	:	US
Telephone Number	:	954-234-4847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1359 E SAMPLE RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6278
Country	:	US
Telephone Number	:	954-234-4847
Fax Number	:

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

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/04/2015

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