Provider Demographics
NPI:1699210914
Name:DESROSIERS, GUERDA (PTA)
Entity Type:Individual
Prefix:
First Name:GUERDA
Middle Name:
Last Name:DESROSIERS
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 1:4407 S KIRKMAN RD # C-207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2867
Mailing Address - Country:US
Mailing Address - Phone:407-272-3474
Mailing Address - Fax:
Practice Address - Street 1:469 CARDINAL CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4440
Practice Address - Country:US
Practice Address - Phone:407-272-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25625171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor