Provider Demographics
NPI:1346909561
Name:ORTIZ MACHUCA, GUILLERMO ANTONIO
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:ANTONIO
Last Name:ORTIZ MACHUCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:54 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-2347
Practice Address - Country:US
Practice Address - Phone:540-234-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
VACP024167T225100000X
CAPT3018122251X0800X
NCP221272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist