Healthcare Provider Details

I. General information

NPI: 1922072040
Provider Name (Legal Business Name): MATTHEW J GUTH ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W KENSINGTON RD
MT PROSPECT IL
60056-1112
US

IV. Provider business mailing address

622 N. GREEWOOD DRIVE
PALATINE IL
60074
US

V. Phone/Fax

Practice location:
  • Phone: 847-718-5403
  • Fax: 847-718-5404
Mailing address:
  • Phone: 847-934-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: