Provider Demographics
NPI:1952110587
Name:GUISHARD FUENTES, KARLA TATIANA (DPT)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:TATIANA
Last Name:GUISHARD FUENTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083-1105
Mailing Address - Country:US
Mailing Address - Phone:475-655-0359
Mailing Address - Fax:203-504-7700
Practice Address - Street 1:1336 W MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3122
Practice Address - Country:US
Practice Address - Phone:203-437-7229
Practice Address - Fax:203-504-7700
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist