Provider Demographics
NPI:1982763975
Name:FLORENTINO, GUILLERMA (PT)
Entity Type:Individual
Prefix:
First Name:GUILLERMA
Middle Name:
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GUILLERMA
Other - Middle Name:ESCANO
Other - Last Name:MEDRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150A TICES LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2015
Mailing Address - Country:US
Mailing Address - Phone:732-254-5553
Mailing Address - Fax:732-238-6194
Practice Address - Street 1:150A TICES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2015
Practice Address - Country:US
Practice Address - Phone:732-254-5553
Practice Address - Fax:732-238-6194
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00475700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist