Healthcare Provider Details

I. General information

NPI: 1558707216
Provider Name (Legal Business Name): MARY ANJELIKA RONQUILLO DE GUZMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 VEIRS DR
ROCKVILLE MD
20850-3414
US

IV. Provider business mailing address

15204 OMEGA DR STE 310
ROCKVILLE MD
20850-4601
US

V. Phone/Fax

Practice location:
  • Phone: 954-695-9166
  • Fax: 855-232-8604
Mailing address:
  • Phone: 240-361-9000
  • Fax: 240-361-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25558
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: