Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT019351 | PA |
NPI | 1063668143 |
---|---|
Provider Name | Clarisa Stephanie Guerrero |
First Address | Mississauga, ONTARIO L4Z1K9 |
Second Address | Heathrow, FL 32746-5352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 08/08/2008 |