Basic Information
| Provider Information | |||||||||
| NPI: | 1699380907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE GUZMAN | ||||||||
| FirstName: | SHAUN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1769 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201181769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035460013 | ||||||||
| FaxNumber: | 7035460017 | ||||||||
| Practice Location | |||||||||
| Address1: | 7764 ARMISTEAD RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | LORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220791961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035460013 | ||||||||
| FaxNumber: | 7035460017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1518724 | WI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1337799 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.