Provider Demographics
NPI:1114476561
Name:VILLADELGADO, GUADALYN NAVARRA
Entity Type:Individual
Prefix:
First Name:GUADALYN
Middle Name:NAVARRA
Last Name:VILLADELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUADALYN
Other - Middle Name:LUZ
Other - Last Name:NAVARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12218 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4223
Mailing Address - Country:US
Mailing Address - Phone:732-575-6364
Mailing Address - Fax:
Practice Address - Street 1:12218 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4223
Practice Address - Country:US
Practice Address - Phone:732-575-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62040874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist