Healthcare Provider Details

I. General information

NPI: 1942830534
Provider Name (Legal Business Name): CHRISTEL ERIKA DE GUZMAN BULLIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTEL ERIKA SISCAR DE GUZMAN PT, DPT

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EASTERN AVE
RED OAK IA
51566-1300
US

IV. Provider business mailing address

2515 NOTTINGHAM DR
BELLEVUE NE
68123-1958
US

V. Phone/Fax

Practice location:
  • Phone: 702-623-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number099390
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: