Individual
MR. AUGUSTO GUERRA AUTEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
8909 BELLEFORTE AVE, MORTON GROVE, IL 60053-2018
(555) 555-5555
Mailing address
16089 POPPYSEED CIR UNIT 2008, DELRAY BEACH, FL 33484-6314
(561) 496-7993
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.019057
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30000776232A
STATE IDENTIFICATION
IL
Enumeration date
07/26/2012
Last updated
06/09/2016
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