Provider Demographics
NPI:1780707661
Name:GUANZON, ROBERT DANIEL (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:GUANZON
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 1:112 MCKNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-3806
Mailing Address - Country:US
Mailing Address - Phone:870-367-0719
Mailing Address - Fax:870-460-0946
Practice Address - Street 1:112 MCKNIGHT DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-3806
Practice Address - Country:US
Practice Address - Phone:870-367-0719
Practice Address - Fax:870-460-0946
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist