Provider Demographics
NPI:1215711593
Name:GUARNACCIA, KATHERINE A (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:GUARNACCIA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DEWITT TER
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1228
Mailing Address - Country:US
Mailing Address - Phone:732-713-1720
Mailing Address - Fax:
Practice Address - Street 1:201 W END PL
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-1850
Practice Address - Country:US
Practice Address - Phone:908-709-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002569002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer