Provider Demographics
NPI:1285009274
Name:GUERRA, MEGAN (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
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 1:52 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4783
Mailing Address - Country:US
Mailing Address - Phone:304-886-9905
Mailing Address - Fax:
Practice Address - Street 1:1175 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5906
Practice Address - Country:US
Practice Address - Phone:301-733-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4051225200000X
WVPTA001935225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant