Provider Demographics
NPI:1447264080
Name:MUECO-GUZMAN, MINERVA LABARDA (PT)
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:LABARDA
Last Name:MUECO-GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MINERVA
Other - Middle Name:LABARDA
Other - Last Name:MUECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2527 FOLIO WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7712
Mailing Address - Country:US
Mailing Address - Phone:407-717-6116
Mailing Address - Fax:
Practice Address - Street 1:2527 FOLIO WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7712
Practice Address - Country:US
Practice Address - Phone:407-717-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022471225100000X
FL22845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist