Provider Demographics
NPI:1013214857
Name:GUTIERREZ, VALERIE A (DPT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 CAMINO DE HIGINO
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9356
Mailing Address - Country:US
Mailing Address - Phone:505-450-3451
Mailing Address - Fax:
Practice Address - Street 1:227 HWY 346
Practice Address - Street 2:
Practice Address - City:BOSQUE
Practice Address - State:NM
Practice Address - Zip Code:87006
Practice Address - Country:US
Practice Address - Phone:505-450-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist