Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 3121959 | TX |
Y | 2251X0800X | Physical Therapist - Orthopedic | 1307600 | TX |
NPI | 1023509098 |
---|---|
Provider Name | Justin Guillot |
First Address | Austin, TX 78731-2281 |
Second Address | Austin, TX 78731-2281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2018 |
Last Update Date | 22/10/2018 |