Healthcare Provider Details

I. General information

NPI: 1417730284
Provider Name (Legal Business Name): ANA GUZMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 CORTEZ RD W
BRADENTON FL
34210-2604
US

IV. Provider business mailing address

6305 CORTEZ RD W
BRADENTON FL
34210-2604
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-3499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27633
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: