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General NPI Number Information
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NPI Number | 1881198091
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Entity Type | Individual
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Provider Name | JUAN GUILLERMO CORREA DPT
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Gender | Male
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 57 W 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 646-790-7464
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Fax | 212-379-2075
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Provider Business Mailing Address
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Address Line | 3704 CLIFF HAVEN DR
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City | RALEIGH
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State | NC
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Zip | 27615-8118
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Country | US
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Telephone | 302-482-5589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 042802-1
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License Number State | NY
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