Provider Demographics
NPI:1710668736
Name:GUAN, BRENDA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 KEENEY ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3203
Mailing Address - Country:US
Mailing Address - Phone:773-715-4168
Mailing Address - Fax:
Practice Address - Street 1:2536 EWING AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1214
Practice Address - Country:US
Practice Address - Phone:847-905-0332
Practice Address - Fax:847-905-0003
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027517208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation