Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA27705 | FL |
NPI | 1013674092 |
---|---|
Provider Name | Tania Guerra |
First Address | Homosassa, FL 34446-5028 |
Second Address | Sarasota, FL 34236-2631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2021 |
Last Update Date | 24/11/2021 |