Active NPI
Mary Johanna De Guzman De Los Reyes, PT
- Physical Therapist
- Philadelphia, PA
National Provider Identifier
1699928382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 22726
- Practice address
- 1628 John F Kennedy Blvd Ste 401
Philadelphia, PA 19103-2120 - Phone
- (215) 557-0057
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 22726 | MD | Primary |
Addresses
Primary practice location
1628 John F Kennedy Blvd Ste 401
Philadelphia, PA 19103-2120
Mailing address
1628 John F Kennedy Blvd Ste 401
Philadelphia, PA 19103-2120
Phone (215) 557-0057
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
| License | State | Type | Specialty |
|---|---|---|---|
| 22726 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1699928382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1628 JOHN F KENNEDY BLVD STE 401",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191032120",
"telephone_number": "215-557-0057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1628 JOHN F KENNEDY BLVD STE 401",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191032120",
"telephone_number": "215-557-0057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LOS REYES",
"first_name": "MARY JOHANNA",
"middle_name": "DE GUZMAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "22726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.