Healthcare Provider Details

I. General information

NPI: 1659673234
Provider Name (Legal Business Name): DANIEL E GUZMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11870 W STATE ROAD 84 C3
DAVIE FL
33325-3816
US

IV. Provider business mailing address

16249 BISCAYNE BLVD
AVENTURA FL
33160-4300
US

V. Phone/Fax

Practice location:
  • Phone: 305-405-0400
  • Fax:
Mailing address:
  • Phone: 305-405-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 22428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: