Provider Demographics
NPI:1992090351
Name:PENA, BLESSIE GUZMAN (RPT)
Entity type:Individual
Prefix:
First Name:BLESSIE
Middle Name:GUZMAN
Last Name:PENA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W SAMPLE RD
Mailing Address - Street 2:APT. 206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3234
Mailing Address - Country:US
Mailing Address - Phone:954-344-4145
Mailing Address - Fax:
Practice Address - Street 1:5800 W SAMPLE RD
Practice Address - Street 2:APT. 206
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3234
Practice Address - Country:US
Practice Address - Phone:954-344-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1205861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist