Provider Demographics
NPI:1992815575
Name:GUERINO, KATHERYN S (PT)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:S
Last Name:GUERINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:S
Other - Last Name:TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:133 FAIRFIELD ST
Mailing Address - Street 2:PO BOX 1370
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1726
Mailing Address - Country:US
Mailing Address - Phone:802-524-1064
Mailing Address - Fax:802-524-1025
Practice Address - Street 1:133 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1726
Practice Address - Country:US
Practice Address - Phone:802-524-1064
Practice Address - Fax:802-524-1025
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00059120OtherBLUE CROSS BLUE SHIELD
391591OtherMVP HEALTHCARE
VT0VN3014Medicaid
VT0VN3014Medicaid