Provider Demographics
NPI:1942264353
Name:GUERRERA, SERGIO (ATC)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:GUERRERA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHARTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2804
Mailing Address - Country:US
Mailing Address - Phone:203-754-2802
Mailing Address - Fax:860-945-7942
Practice Address - Street 1:110 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2130
Practice Address - Country:US
Practice Address - Phone:860-945-7927
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2255A2300XOtherATHLETIC TRAINER