Provider Demographics
NPI:1033490644
Name:GUTIERREZ, ASHLEY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3699 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6559
Mailing Address - Country:US
Mailing Address - Phone:405-387-5520
Mailing Address - Fax:405-387-5404
Practice Address - Street 1:3699 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6559
Practice Address - Country:US
Practice Address - Phone:405-387-5520
Practice Address - Fax:405-387-5404
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist