1770821332 NPI number — MRS. BETHANY ANGELA GUERRA PT, DPT

Table of content: MRS. BETHANY ANGELA GUERRA PT, DPT (NPI 1770821332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770821332 NPI number — MRS. BETHANY ANGELA GUERRA PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRA
Provider First Name:
BETHANY
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770821332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 W FM 544
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094-4581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-578-0306
Provider Business Mailing Address Fax Number:
972-578-0514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 W FM 544
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75094-4581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-578-0306
Provider Business Practice Location Address Fax Number:
972-578-0514
Provider Enumeration Date:
01/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1220010 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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