Provider Demographics
NPI:1730387739
Name:GUZZARDO, KENNETH A (PT, DPT, OCS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:GUZZARDO
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TUCKERTON RD
Mailing Address - Street 2:STE 17
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8806
Mailing Address - Country:US
Mailing Address - Phone:856-396-2250
Mailing Address - Fax:856-810-0373
Practice Address - Street 1:200 TUCKERTON RD
Practice Address - Street 2:STE 17
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8806
Practice Address - Country:US
Practice Address - Phone:856-396-2250
Practice Address - Fax:856-810-0373
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO017218L225100000X
PAPT017218225100000X
NJ40QA012516002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
177689XAHMedicare PIN