Provider Demographics
NPI:1619996113
Name:DE GUZMAN, ELIZABETH C (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:C
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 BAYWAY AVE
Mailing Address - Street 2:APT # C
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2560
Mailing Address - Country:US
Mailing Address - Phone:908-469-4090
Mailing Address - Fax:
Practice Address - Street 1:221 CHESTNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1297
Practice Address - Country:US
Practice Address - Phone:908-620-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01025900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist