Provider Demographics
NPI:1043661879
Name:GUERRERO, MIRIAM INES
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:INES
Last Name:GUERRERO
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 1:1410 FRANK CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-5673
Mailing Address - Country:US
Mailing Address - Phone:931-704-0668
Mailing Address - Fax:
Practice Address - Street 1:1410 FRANK CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-5673
Practice Address - Country:US
Practice Address - Phone:931-704-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027455Medicaid