Provider Demographics
NPI:1881248201
Name:GUZMAN, REBECCA TENIEL (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:TENIEL
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:TENIEL
Other - Last Name:KOZLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 N BROOKSIDE DR APT 1012
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-7513
Mailing Address - Country:US
Mailing Address - Phone:559-451-1444
Mailing Address - Fax:
Practice Address - Street 1:5800 OWNBY DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205
Practice Address - Country:US
Practice Address - Phone:559-451-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT87252255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer