Provider Demographics
NPI:1902318835
Name:GUERRA, LISSETTE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:MARIE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 MUSGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8188
Mailing Address - Country:US
Mailing Address - Phone:321-591-2969
Mailing Address - Fax:941-360-1998
Practice Address - Street 1:2970 UNIVERSITY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2401
Practice Address - Country:US
Practice Address - Phone:941-360-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist