MEDICARE: KRISTEN ANNE GUZAK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2015028681	MO
2	225100000X	Physical Therapist	9780	SC

General Provider Information

NPI Number	:	1063889947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ANNE GUZAK DPT

Provider Business Mailing Address
First Line	:	14450 S OUTER 40 RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-5711
Country	:	US
Telephone Number	:	314-434-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 W WESMARK BLVD
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-1955
Country	:	US
Telephone Number	:	803-938-5395
Fax Number	:	803-938-5396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	07/22/2019

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