Healthcare Provider Details

I. General information

NPI: 1063681575
Provider Name (Legal Business Name): CLAIRE THERESE GUIDA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE UPDEGROVE

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CIR
WINCHESTER VA
22601-3322
US

IV. Provider business mailing address

PO BOX 2217
WINCHESTER VA
22604-1417
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-7076
  • Fax: 540-667-5773
Mailing address:
  • Phone: 540-667-8975
  • Fax: 540-667-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2305202304
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: