Provider Demographics
NPI:1053852632
Name:GUERRA, DELLA GRACE (PTA)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:GRACE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13226 SW 17TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-4011
Mailing Address - Country:US
Mailing Address - Phone:352-304-2410
Mailing Address - Fax:
Practice Address - Street 1:13940 US-441 #702
Practice Address - Street 2:ALL COAST THERAPY SERVICES OUTPATIENT INC.
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-751-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 26378225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant