Provider Demographics
NPI:1518566140
Name:GUANGCO, ALVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:
Last Name:GUANGCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 VALENTINE RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3592
Mailing Address - Country:US
Mailing Address - Phone:765-319-8420
Mailing Address - Fax:844-874-6349
Practice Address - Street 1:2320 VALENTINE RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3592
Practice Address - Country:US
Practice Address - Phone:765-319-8420
Practice Address - Fax:844-874-6349
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003809A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist