=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942720701
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUADALUPE DELENE MESA PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2017
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 BURRO ALY
-----------------------------------------------------
City | MORENCI
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85540-9647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-865-9184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 218
-----------------------------------------------------
City | MORENCI
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85540-0218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-865-7500
-----------------------------------------------------
Fax | 928-865-9186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 12934A
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------