Provider Demographics
NPI:1689080095
Name:GARCIA, KAROLINA
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19965 FM 3175
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-3481
Mailing Address - Country:US
Mailing Address - Phone:210-357-0335
Mailing Address - Fax:830-709-5493
Practice Address - Street 1:39 SCENIC LOOP RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8608
Practice Address - Country:US
Practice Address - Phone:210-504-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1249171225100000X
TX3116286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00636YMedicare PIN
TX00X553Medicare PIN
TX403118YT6UMedicare PIN
TX403118YLHEMedicare PIN