Individual provider Active NPI

Roy John De Guzman

  • Physical Therapist
  • Las Vegas, NV
National Provider Identifier
1477615508
Registry record updated Dec 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2034 Issued in NV
Practice address
4850 W Flamingo Rd Ste 25B
Las Vegas, NV 89103-3707
Phone
(702) 871-9917
Fax
(702) 871-9918
NPI assigned
Dec 14, 2006
Last updated
Dec 4, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2034 NV Primary

Addresses

Primary practice location

4850 W Flamingo Rd Ste 25B
Las Vegas, NV 89103-3707

Mailing address

4850 W Flamingo Rd Ste 25B
Las Vegas, NV 89103-3707
Phone (702) 871-9917

Other identifiers 1

IdentifierTypeStateIssuer
2034OtherNVPHYSICAL THERAPY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2034NVMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512345600000",
    "number": "1477615508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 W FLAMINGO RD STE 25B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891033707",
            "telephone_number": "702-871-9917",
            "fax_number": "702-871-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 W FLAMINGO RD STE 25B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891033707",
            "telephone_number": "702-871-9917",
            "fax_number": "702-871-9918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GUZMAN",
        "first_name": "ROY",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2017-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "2034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY",
            "identifier": "2034",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.