Provider Demographics
NPI:1750393583
Name:GUEVARRA, AVA (RPT)
Entity type:Individual
Prefix:MRS
First Name:AVA
Middle Name:
Last Name:GUEVARRA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CHANDLER CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6468
Mailing Address - Country:US
Mailing Address - Phone:843-774-7462
Mailing Address - Fax:843-841-2482
Practice Address - Street 1:126 N MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3434
Practice Address - Country:US
Practice Address - Phone:843-774-7462
Practice Address - Fax:843-841-2482
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist