Provider Demographics
NPI:1457509929
Name:DE GUZMAN, JANICE YASANA (RPT)
Entity Type:Individual
Prefix:MISS
First Name:JANICE
Middle Name:YASANA
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E 78TH ST
Mailing Address - Street 2:2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1132
Mailing Address - Country:US
Mailing Address - Phone:646-409-3874
Mailing Address - Fax:
Practice Address - Street 1:523 E 78TH ST
Practice Address - Street 2:2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1132
Practice Address - Country:US
Practice Address - Phone:646-409-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist