Basic Information
| Provider Information | |||||||||
| NPI: | 1245997295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUICO | ||||||||
| FirstName: | THEO CARLO | ||||||||
| MiddleName: | MAGADIA | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 PALMER AVE | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069025338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035640512 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 PARSONAGE RD | ||||||||
| Address2: | |||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068303941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777873430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 008440 | CT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.