Provider Demographics
NPI:1689389058
Name:GUILLEN, ENRIQUE (PT)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2417 WELSH ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-5631
Mailing Address - Country:US
Mailing Address - Phone:267-639-2555
Mailing Address - Fax:215-613-5631
Practice Address - Street 1:2200 HAMILTON STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6337
Practice Address - Country:US
Practice Address - Phone:484-273-0401
Practice Address - Fax:484-268-5265
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT030974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist