Provider Demographics
NPI:1366072514
Name:ARTILLERO, LADY
Entity type:Individual
Prefix:MISS
First Name:LADY
Middle Name:
Last Name:ARTILLERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8838
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-8838
Mailing Address - Country:US
Mailing Address - Phone:671-647-5355
Mailing Address - Fax:671-647-5358
Practice Address - Street 1:809 CHALAN PASAHERU UNIT 2
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4132
Practice Address - Country:US
Practice Address - Phone:671-647-5355
Practice Address - Fax:671-647-5358
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPT-146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist