Provider Demographics
NPI:1689980633
Name:GUERRA, CARRIE L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:GUERRA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BONNIE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2903
Mailing Address - Country:US
Mailing Address - Phone:401-316-0790
Mailing Address - Fax:
Practice Address - Street 1:77 BONNIE BROOK DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-2903
Practice Address - Country:US
Practice Address - Phone:401-316-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12051225100000X
RIPT01401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist