Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 6398 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 6398 | AZ |
N | 2251H1200X | Hand | 6398 | AZ |
N | 2251P0200X | Physical Therapist - Pediatrics | 6398 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 6398 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 6398 | AZ |
NPI | 1336181569 |
---|---|
Provider Name | Kyle David Guidry |
First Address | Sun City West, AZ 85375-5286 |
Second Address | Sun City West, AZ 85375-5286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106584 | (05) | AZ |