Provider Demographics
NPI:1568679850
Name:GUGGINO, ANGELA M (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:M
Last Name:GUGGINO
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 ELLISON LAKES DR NW
Mailing Address - Street 2:APT. 717
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8248
Mailing Address - Country:US
Mailing Address - Phone:770-423-2007
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD 41 HWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1072
Practice Address - Country:US
Practice Address - Phone:770-975-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer