Provider Demographics
NPI:1851807101
Name:GUERRERO, ANDRES (PTA)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 LANDER ST APT 36
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2078
Mailing Address - Country:US
Mailing Address - Phone:718-314-6474
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:8411 LANDER ST APT 36
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2078
Practice Address - Country:US
Practice Address - Phone:718-314-6474
Practice Address - Fax:718-377-5002
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant