Provider Demographics
NPI:1972971091
Name:GUZZO, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:GUZZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 104TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7968
Mailing Address - Country:US
Mailing Address - Phone:563-271-4506
Mailing Address - Fax:
Practice Address - Street 1:4420 104TH ST APT 11
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7968
Practice Address - Country:US
Practice Address - Phone:563-271-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078506225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant