Basic Information
| Provider Information | |||||||||
| NPI: | 1558707216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE GUZMAN | ||||||||
| FirstName: | MARY ANJELIKA | ||||||||
| MiddleName: | RONQUILLO | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15204 OMEGA DR | ||||||||
| Address2: | STE 310 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403619000 | ||||||||
| FaxNumber: | 2403619001 | ||||||||
| Practice Location | |||||||||
| Address1: | 9701 VEIRS DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546959166 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2013 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 25558 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.