Provider Demographics
NPI:1861861684
Name:GUZA, NATHAN CLARK (PTA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CLARK
Last Name:GUZA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-6405
Mailing Address - Country:US
Mailing Address - Phone:406-728-9162
Mailing Address - Fax:
Practice Address - Street 1:4718 23RD AVE STE 500
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1133
Practice Address - Country:US
Practice Address - Phone:406-728-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7685225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant