Provider Demographics
NPI:1669632212
Name:GUERRA, JAMES (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 OAK PARK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1821
Mailing Address - Country:US
Mailing Address - Phone:805-473-7499
Mailing Address - Fax:805-473-7494
Practice Address - Street 1:880 OAK PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1821
Practice Address - Country:US
Practice Address - Phone:805-473-7499
Practice Address - Fax:805-473-7494
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT33733OtherMEDICAL LICENSE