Provider Demographics
NPI:1629711908
Name:NULUD, DAVID JOHN GUZMAN (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID JOHN
Middle Name:GUZMAN
Last Name:NULUD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4017
Mailing Address - Country:US
Mailing Address - Phone:773-942-6528
Mailing Address - Fax:773-293-6550
Practice Address - Street 1:2655 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4017
Practice Address - Country:US
Practice Address - Phone:773-942-6528
Practice Address - Fax:773-293-6550
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160009445225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant