MEDICARE: JAN BRIAN DE GUZMAN MENDOZA

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	PT6329	ME

General Provider Information

NPI Number	:	1104771427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN BRIAN DE GUZMAN MENDOZA

Provider Business Mailing Address
First Line	:	71 MAIN ST APT 2
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-2864
Country	:	US
Telephone Number	:	207-769-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 MAIN ST APT 2
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-2864
Country	:	US
Telephone Number	:	207-769-8207
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ JAN BRIAN DE GUZMAN MENDOZA ” Practice Location

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