Provider Demographics
NPI:1992879894
Name:GUEVARRA, PAMELA G (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:GUEVARRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10324 N 62ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1231
Mailing Address - Country:US
Mailing Address - Phone:602-778-0900
Mailing Address - Fax:602-778-6606
Practice Address - Street 1:13644 N 75TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6085
Practice Address - Country:US
Practice Address - Phone:623-979-8900
Practice Address - Fax:623-979-1809
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112573Medicare PIN