Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11400 | NC |
NPI | 1003093782 |
---|---|
Provider Name | Mr. Arnold De Guzman |
First Address | Gastonia, NC 28054-1478 |
Second Address | Gastonia, NC 28054-1478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 24/01/2008 |