Provider Demographics
NPI:1497323463
Name:SLATTON, MARIA TRINA GUZMAN (RPT)
Entity Type:Individual
Prefix:
First Name:MARIA TRINA
Middle Name:GUZMAN
Last Name:SLATTON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARIA TRINA
Other - Middle Name:GUZMAN
Other - Last Name:SAN JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:240 MARIETTA HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2311
Mailing Address - Country:US
Mailing Address - Phone:770-720-0290
Mailing Address - Fax:
Practice Address - Street 1:240 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2311
Practice Address - Country:US
Practice Address - Phone:770-720-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT007891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist