Healthcare Provider Details

I. General information

NPI: 1780694497
Provider Name (Legal Business Name): BETTE MCCOMBS GUZMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 BOULDER DR
PLEASANT HILL IA
50327-2308
US

IV. Provider business mailing address

5180 BOULDER DR SUITE 1020
PLEASANT HILL IA
50327-2308
US

V. Phone/Fax

Practice location:
  • Phone: 515-339-0405
  • Fax:
Mailing address:
  • Phone: 515-339-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT00003555
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004154
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: