Basic Information
| Provider Information | |||||||||
| NPI: | 1023509098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUILLOT | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 E WADSWORTH PARK DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | DRAPER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840208096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3853088034 | ||||||||
| FaxNumber: | 3853088034 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 E WADSWORTH PARK DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | DRAPER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840208096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3853088034 | ||||||||
| FaxNumber: | 3853088034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3121959 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 1307600 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.