MEDICARE: MR. ROBERT JOSEPH GUIDRY JR. PHYSICAL THERAPIST

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	04393	LA
2	2251X0800X	Orthopedic Physical Therapist	04393	LA

General Provider Information

NPI Number	:	1760581623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JOSEPH GUIDRY JR. PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	37427 MILL PARK AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737
Country	:	US
Telephone Number	:	225-241-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	37427 MILL PARK AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-6198
Country	:	US
Telephone Number	:	225-241-0122
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/23/2016

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