Provider Demographics
NPI:1174783047
Name:DE GUZMAN, CATALINA ROSE TAMAYO (PT)
Entity type:Individual
Prefix:MISS
First Name:CATALINA ROSE
Middle Name:TAMAYO
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2880
Mailing Address - Country:US
Mailing Address - Phone:707-386-7912
Mailing Address - Fax:
Practice Address - Street 1:25117 SW PARKWAY STE D
Practice Address - Street 2:INFINITY REHAB
Practice Address - City:WILLSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist