Healthcare Provider Details

I. General information

NPI: 1740839745
Provider Name (Legal Business Name): REBECCA GUZZO MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N CAMPUS
ITHACA NY
14853-6007
US

IV. Provider business mailing address

521 N CAMPUS
ITHACA NY
14853-6007
US

V. Phone/Fax

Practice location:
  • Phone: 607-255-4237
  • Fax:
Mailing address:
  • Phone: 607-255-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002987
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: