Provider Demographics
NPI:1477615508
Name:DE GUZMAN, ROY JOHN
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:JOHN
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 W FLAMINGO RD STE 25B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3707
Mailing Address - Country:US
Mailing Address - Phone:702-871-9917
Mailing Address - Fax:702-871-9918
Practice Address - Street 1:4850 W FLAMINGO RD STE 25B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3707
Practice Address - Country:US
Practice Address - Phone:702-871-9917
Practice Address - Fax:702-871-9918
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2034225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2034OtherPHYSICAL THERAPY