Healthcare Provider Details

I. General information

NPI: 1376269860
Provider Name (Legal Business Name): PABLO GUERRERO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21083 N JOHN WAYNE PKWY
MARICOPA AZ
85139-2959
US

IV. Provider business mailing address

4451 SW 162ND CT
MIAMI FL
33185-3846
US

V. Phone/Fax

Practice location:
  • Phone: 520-233-7555
  • Fax:
Mailing address:
  • Phone: 786-252-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11155R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT38056
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberLPT-32645
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: