Provider Demographics
NPI:1811569338
Name:NUGUID, FREDERICK NEPOMUCENO (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:NEPOMUCENO
Last Name:NUGUID
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3497 N CHATHAM RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3905
Mailing Address - Country:US
Mailing Address - Phone:917-297-5141
Mailing Address - Fax:
Practice Address - Street 1:3497 N CHATHAM RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3905
Practice Address - Country:US
Practice Address - Phone:917-297-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist