MEDICARE: AUREA GINA M GUISADIO PT

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	04519	TN

General Provider Information

NPI Number	:	1285728634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUREA GINA M GUISADIO PT

Provider Business Mailing Address
First Line	:	1844 ROSA CIRCLE
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814
Country	:	US
Telephone Number	:	423-748-4800
Fax Number	:	423-585-5889

Provider Business Practice Location Address
First Line	:	5250 WEST A.J. HIGHWAY
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814
Country	:	US
Telephone Number	:	423-748-4800
Fax Number	:	423-585-5889

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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