Basic Information
| Provider Information | |||||||||
| NPI: | 1013674092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUERRA | ||||||||
| FirstName: | TANIA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8477 S SUNCOAST BLVD | ||||||||
| Address2: | |||||||||
| City: | HOMOSASSA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344465028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008049961 | ||||||||
| FaxNumber: | 3523821146 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342362631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413650250 | ||||||||
| FaxNumber: | 3523821146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA27705 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.