Provider Demographics
NPI:1558899146
Name:GUAJARDO, ANYSSA M (PT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ANYSSA
Middle Name:M
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:PT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 POST OAKS RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6941
Mailing Address - Country:US
Mailing Address - Phone:956-219-8249
Mailing Address - Fax:
Practice Address - Street 1:5750 E HIGHWAY 90 STE 100
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9112
Practice Address - Country:US
Practice Address - Phone:520-263-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXAT72782255A2300X
TX1361281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer