Provider Demographics
NPI:1861055758
Name:GARCIA, EDDIE RAUL (ATC)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:RAUL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 NE BRANDI WAY APT B102
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5309
Mailing Address - Country:US
Mailing Address - Phone:425-970-5682
Mailing Address - Fax:
Practice Address - Street 1:1365 NE BRANDI WAY APT B102
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5309
Practice Address - Country:US
Practice Address - Phone:425-970-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1609717182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer