Provider Demographics
NPI:1063668143
Name:GUERRERO, CLARISA STEPHANIE (DPT)
Entity Type:Individual
Prefix:
First Name:CLARISA
Middle Name:STEPHANIE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 CHALFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4Z1K9
Mailing Address - Country:CA
Mailing Address - Phone:905-896-7551
Mailing Address - Fax:
Practice Address - Street 1:1485 INTERNATIONAL PKWY STE 2051
Practice Address - Street 2:
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5352
Practice Address - Country:US
Practice Address - Phone:888-798-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0193512251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics