Provider Demographics
NPI:1538778915
Name:GUILLEN, RICHARD BRYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRYAN
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 DOUGLAS AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5941
Mailing Address - Country:US
Mailing Address - Phone:693-720-0214
Mailing Address - Fax:
Practice Address - Street 1:8222 DOUGLAS AVE STE 430
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5941
Practice Address - Country:US
Practice Address - Phone:469-372-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1331853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist