Provider Demographics
NPI:1134559958
Name:GARCIA-GAONA, MANUEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:GARCIA-GAONA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-1512
Mailing Address - Country:US
Mailing Address - Phone:770-539-0011
Mailing Address - Fax:
Practice Address - Street 1:19 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:GA
Practice Address - Zip Code:30628-1512
Practice Address - Country:US
Practice Address - Phone:770-539-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-6045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist