Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1219611 | TX |
NPI | 1043561327 |
---|---|
Provider Name | Maria Jose Guerra |
First Address | San Antonio, TX 78296-1607 |
Second Address | San Antonio, TX 78233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 08/12/2014 |