Healthcare Provider Details

I. General information

NPI: 1700719192
Provider Name (Legal Business Name): RUSTY SUGUITAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 SAINT JOHN AVE S
BOYNTON BEACH FL
33472-1112
US

IV. Provider business mailing address

5170 SAINT JOHN AVE S
BOYNTON BEACH FL
33472-1112
US

V. Phone/Fax

Practice location:
  • Phone: 321-240-8420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: