Provider Demographics
NPI:1275427627
Name:GARCIA, EDGAR DYLAN JR (PTA)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:DYLAN
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11132 AMESTOY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4108
Mailing Address - Country:US
Mailing Address - Phone:818-304-1916
Mailing Address - Fax:
Practice Address - Street 1:19232 LANARK ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1120
Practice Address - Country:US
Practice Address - Phone:818-304-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant