Healthcare Provider Details

I. General information

NPI: 1760711691
Provider Name (Legal Business Name): MRS. LISET GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 49TH ST
HIALEAH FL
33012-3323
US

IV. Provider business mailing address

254 FLAGLER DR APT 3
MIAMI SPRINGS FL
33166-4967
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-1254
  • Fax:
Mailing address:
  • Phone: 786-287-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA21968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: