Provider Demographics
NPI:1427695527
Name:SICAT, ROLANDO GUIAO JR (PT)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:GUIAO
Last Name:SICAT
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PROSPECT AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1434
Mailing Address - Country:US
Mailing Address - Phone:929-476-4969
Mailing Address - Fax:
Practice Address - Street 1:400 PROSPECT AVE APT 5
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1434
Practice Address - Country:US
Practice Address - Phone:929-476-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist