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General NPI Number Information
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NPI Number | 1962779108
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Entity Type | Individual
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Provider Name | GUILLERMO I VALLEJOS PT
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Gender | Male
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 220 N SYKES CREEK PKWY STE 201
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3490
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Country | US
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Telephone | 321-521-1161
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Fax | 321-521-1161
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Provider Business Mailing Address
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Address Line | 100 E 2ND AVE STE 210
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City | ROME
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State | GA
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Zip | 30161-1718
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Country | US
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Telephone | 321-521-1161
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Fax | 321-521-1161
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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 | PT2534
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT31117
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License Number State | FL
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