Provider Demographics
NPI:1699870774
Name:GUILLIANO, SHIRLEY (PT)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:GUILLIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-3486
Mailing Address - Country:US
Mailing Address - Phone:423-322-4332
Mailing Address - Fax:
Practice Address - Street 1:1408 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-6434
Practice Address - Country:US
Practice Address - Phone:706-638-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist