Individual provider Active NPI

David John Guzman Nulud, PTA

  • Physical Therapy Assistant
  • Chicago, IL
National Provider Identifier
1629711908
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
160009445 Issued in IL
Practice address
2655 W Peterson Ave
Chicago, IL 60659-4017
Phone
(773) 942-6528
Fax
(773) 293-6550
NPI assigned
Apr 15, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 160009445 IL Primary

Addresses

Primary practice location

2655 W Peterson Ave
Chicago, IL 60659-4017

Mailing address

2655 W Peterson Ave
Chicago, IL 60659-4017
Phone (773) 942-6528

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
160009445ILMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1629711908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594017",
            "telephone_number": "773-942-6528",
            "fax_number": "773-293-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594017",
            "telephone_number": "773-942-6528",
            "fax_number": "773-293-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NULUD",
        "first_name": "DAVID JOHN",
        "middle_name": "GUZMAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160009445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.