Provider Demographics
NPI:1669494753
Name:GUESSFORD, DOMINICK JOSEPH (PTA, ATC)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:JOSEPH
Last Name:GUESSFORD
Suffix:
Gender:M
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5819
Mailing Address - Country:US
Mailing Address - Phone:410-620-2886
Mailing Address - Fax:
Practice Address - Street 1:223 EAST MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911
Practice Address - Country:US
Practice Address - Phone:410-658-5500
Practice Address - Fax:410-658-3910
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2855225200000X
MD2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer