Provider Demographics
NPI:1053785428
Name:GUZMAN, HEATHER PEGGY
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:PEGGY
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9520
Mailing Address - Country:US
Mailing Address - Phone:413-244-4972
Mailing Address - Fax:
Practice Address - Street 1:279 CABOT ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3139
Practice Address - Country:US
Practice Address - Phone:413-536-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8217225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant