Stephanie Keith Tago Guivencan, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

044779-01 Issued in NY

Practice address

10825 63Rd Ave
Forest Hills, NY 11375-1342

Phone

(718) 896-2011

NPI assigned

Feb 27, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Touro Un Col of Osteopathic Medicine, New York, 2023

Medicare assignment

May accept Medicare assignment

Group practices

Chang Health Physical Therapy PCGroup PAC ID 8921341868, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chang Health Physical Therapy P.C.

  • Physical Therapy Clinic/Center
  • Bronx, NY
  • NPI 1376006668

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Physio Vista Physical Therapy PLLC

  • Physical Therapist
  • Yonkers, NY
  • NPI 1811703127
  NPD Authorized official
• Fresh Pond Physical Therapy, P.C

  • Physical Therapy Clinic/Center
  • Ridgewood, NY
  • NPI 1508844036
  Medicare reassignment

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

{
    "created_epoch": "1645920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762041600000",
    "number": "1881340974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6121 SAUNDERS ST",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741026",
            "telephone_number": "929-235-4336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10825 63RD AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113751342",
            "telephone_number": "718-896-2011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2488 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104585203",
            "country_code": "US",
            "telephone_number": "718-733-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUIVENCAN",
        "first_name": "STEPHANIE KEITH",
        "middle_name": "TAGO",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-27",
        "last_updated": "2025-11-02",
        "certification_date": "2025-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "044779-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina Guerrero
• Taeishaa Guerrier, LMSW
• Yael Lee Guevara
• Tamara Guichard, MD
• Louis P Guillaume, OPA
• Marina Gulko, LMSW
• Nia Gumbs, M.S.E.D
• Marvin Gunz, P.A.
• Hua Guo
• Meenu Gupta, M.D.

• Physical Therapist in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.