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NPI Code Detail

MEDICARE: BOANERGES GUZMAN DPT

MEDICARE: BOANERGES GUZMAN 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
1225100000XPhysical TherapistPT61423712WA

General Provider Information

NPI Number : 1083397475
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOANERGES GUZMAN DPT
Provider Business Mailing Address
First Line : PO BOX 540640
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-0640
Country : US
Telephone Number : 801-987-8600
Fax Number :
Provider Business Practice Location Address
First Line : 513 1ST AVE
Second Line :
City : ZILLAH
State : WA
Zip : 98953-9432
Country : US
Telephone Number : 509-829-5230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2023
Last Update Date : 11/11/2024

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Directions to “ BOANERGES GUZMAN DPT” Practice Location

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