Provider Demographics
NPI:1558707216
Name:DE GUZMAN, MARY ANJELIKA RONQUILLO (PT)
Entity Type:Individual
Prefix:
First Name:MARY ANJELIKA
Middle Name:RONQUILLO
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:15204 OMEGA DR
Mailing Address - Street 2:STE 310
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4601
Mailing Address - Country:US
Mailing Address - Phone:240-361-9000
Mailing Address - Fax:240-361-9001
Practice Address - Street 1:9701 VEIRS DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3414
Practice Address - Country:US
Practice Address - Phone:954-695-9166
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist