Provider Demographics
NPI:1114476561
Name:NAVARRA, GUADALYN LUZ
Entity type:Individual
Prefix:
First Name:GUADALYN
Middle Name:LUZ
Last Name:NAVARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUADALYN
Other - Middle Name:LUZ
Other - Last Name:NAVARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:100 NEEDHAM ST FL 2
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1500
Practice Address - Country:US
Practice Address - Phone:781-444-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62040874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist