Provider Demographics
NPI:1609009356
Name:GUIDROZ, BEAU A (PT)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:A
Last Name:GUIDROZ
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 1:617 CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-8015
Mailing Address - Country:US
Mailing Address - Phone:318-613-4933
Mailing Address - Fax:
Practice Address - Street 1:54 S PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4619
Practice Address - Country:US
Practice Address - Phone:901-257-3422
Practice Address - Fax:901-257-3423
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000008450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist