Provider Demographics
NPI:1659673234
Name:GUZMAN, DANIEL E (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:GUZMAN
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 1:16249 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4300
Mailing Address - Country:US
Mailing Address - Phone:305-405-0400
Mailing Address - Fax:
Practice Address - Street 1:11870 W STATE ROAD 84
Practice Address - Street 2:C3
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-3816
Practice Address - Country:US
Practice Address - Phone:305-405-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 22428225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887989300Medicaid
FL887989300Medicaid