Individual
JOHNNA LYNN GARCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1126 COULSON AVE, KEMMERER, WY 83101-3947
(208) 819-0439
Mailing address
1126 COULSON AVE, KEMMERER, WY 83101-3947
(208) 819-0439
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1524
WY
225100000X
Physical Therapist
8161046-2401
UT
225100000X
Physical Therapist
PT1952
ID
225100000X
Physical Therapist
PTL0011581
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149982
REGENCE BLUE SHIELD
ID
01
—
0195259
WASHINGTON L&I
WA
05
—
807142500
—
ID
01
—
P00227390
RAILROAD MEDICARE
ID
01
—
TC241
BLUE CROSS
ID
Enumeration date
10/17/2006
Last updated
02/25/2015
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