Provider Demographics
NPI:1902863947
Name:GUARDADO, VIOLETA SUSAN (MPT)
Entity Type:Individual
Prefix:MS
First Name:VIOLETA
Middle Name:SUSAN
Last Name:GUARDADO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:V SUSAN
Other - Middle Name:
Other - Last Name:GUARDADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:6935 LAUREL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4413
Mailing Address - Country:US
Mailing Address - Phone:301-718-2820
Mailing Address - Fax:301-718-2821
Practice Address - Street 1:6935 LAUREL AVE STE 202
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4413
Practice Address - Country:US
Practice Address - Phone:301-718-2820
Practice Address - Fax:301-718-2821
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBCBSOther555AVS
MDBCBSOtherJ496