Provider Demographics
NPI:1063889947
Name:GUZAK, KRISTEN ANNE (DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:GUZAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14450 S OUTER 40 RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5711
Mailing Address - Country:US
Mailing Address - Phone:314-434-6060
Mailing Address - Fax:
Practice Address - Street 1:75 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1955
Practice Address - Country:US
Practice Address - Phone:803-938-5395
Practice Address - Fax:803-938-5396
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028681225100000X
SC9780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist