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General NPI Number Information
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NPI Number | 1952110587
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Entity Type | Individual
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Provider Name | KARLA TATIANA GUISHARD FUENTES DPT
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1336 W MAIN ST STE 1B
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City | WATERBURY
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State | CT
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Zip | 06708-3122
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Country | US
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Telephone | 203-437-7229
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Fax | 203-504-7700
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Provider Business Mailing Address
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Address Line | PO BOX 1105
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City | ENFIELD
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State | CT
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Zip | 06083-1105
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Country | US
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Telephone | 475-655-0359
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Fax | 203-504-7700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14721
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License Number State | CT
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