MEDICARE: MONICA JOANNA GUILLEN P.T.

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

General Provider Information

NPI Number	:	1700974086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA JOANNA GUILLEN P.T.

Provider Business Mailing Address
First Line	:	8702 DREXEL HILL PL
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19231 MONTGOMERY VILLAGE AVE
Second Line	:	SUITE D21
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5023
Country	:	US
Telephone Number	:	301-977-6777
Fax Number	:	301-977-0108

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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Directions to “ MONICA JOANNA GUILLEN P.T.” Practice Location

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