Basic Information
| Provider Information | |||||||||
| NPI: | 1942720701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARSNESS | ||||||||
| FirstName: | GUADALUPE | ||||||||
| MiddleName: | DELENE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 E G ST | ||||||||
| Address2: | |||||||||
| City: | LORDSBURG | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880451504 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 BURRO ALY | ||||||||
| Address2: | |||||||||
| City: | MORENCI | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855409647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9288659184 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2017 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 12934A | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.