Provider Demographics
NPI:1366012908
Name:GUZMAN, ANTONIO (MT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 E SHEA BLVD STE 1330
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6736
Mailing Address - Country:US
Mailing Address - Phone:602-505-8423
Mailing Address - Fax:
Practice Address - Street 1:7000 E SHEA BLVD STE 1330
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6736
Practice Address - Country:US
Practice Address - Phone:602-505-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-24686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist