Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 7659 | AZ |
Y | 2251P0200X | Physical Therapist - Pediatrics | 7659 | AZ |
NPI | 1073726642 |
---|---|
Provider Name | Kristen Guise |
First Address | Mesa, AZ 85206-2148 |
Second Address | Mesa, AZ 85206-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 19/04/2010 |