Provider Demographics
NPI:1861169815
Name:ADA, TASI ANN GUERRERO (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:TASI ANN
Middle Name:GUERRERO
Last Name:ADA
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:DR
Other - First Name:TASI
Other - Middle Name:GUERRERO
Other - Last Name:ADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, CSCS
Mailing Address - Street 1:PO BOX 3854
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-3854
Mailing Address - Country:US
Mailing Address - Phone:671-683-6600
Mailing Address - Fax:
Practice Address - Street 1:185 DULCE NOMBRE DE MARIA DR
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-4909
Practice Address - Country:US
Practice Address - Phone:671-989-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214606261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy