Healthcare Provider Details

I. General information

NPI: 1366012908
Provider Name (Legal Business Name): ANTONIO GUZMAN MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E SHEA BLVD STE 1330
SCOTTSDALE AZ
85254-6736
US

IV. Provider business mailing address

7000 E SHEA BLVD STE 1330
SCOTTSDALE AZ
85254-6736
US

V. Phone/Fax

Practice location:
  • Phone: 602-505-8423
  • Fax:
Mailing address:
  • Phone: 602-505-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-24686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: