MEDICARE: GURU PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1156695	OTHER	TX	STATE PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1861126104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GURU PT

Provider Business Mailing Address
First Line	:	103 W GIBSON ST STE 100
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-4970
Country	:	US
Telephone Number	:	409-382-2713
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 W GIBSON ST STE 100
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-4970
Country	:	US
Telephone Number	:	409-382-2713
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PIERRE NAVARRETE
Credential	:
Telephone Number	:	409-382-2713

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	01/02/2023

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Directions to “GURU PT ” Practice Location

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