Provider Demographics
NPI:1710288436
Name:STANLEY GUSMAN RPT,PA
Entity Type:Organization
Organization Name:STANLEY GUSMAN RPT,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-482-7474
Mailing Address - Street 1:9060 KIMBERLY BLVD
Mailing Address - Street 2:44
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2842
Mailing Address - Country:US
Mailing Address - Phone:561-482-7474
Mailing Address - Fax:561-482-3791
Practice Address - Street 1:9060 KIMBERLY BLVD
Practice Address - Street 2:44
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2842
Practice Address - Country:US
Practice Address - Phone:561-482-7474
Practice Address - Fax:561-482-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2297Medicare PIN