Provider Demographics
NPI:1376886333
Name:GUERRA, SUSAN LYNNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNNE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 ZANE DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7709
Mailing Address - Country:US
Mailing Address - Phone:970-946-1621
Mailing Address - Fax:484-906-7916
Practice Address - Street 1:337 ZANE DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7709
Practice Address - Country:US
Practice Address - Phone:970-946-1621
Practice Address - Fax:484-906-7916
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77282251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics