Provider Demographics
NPI:1164866679
Name:GUTMANN, JULIE ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:GUTMANN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 ATRISCO DR NW
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4907
Mailing Address - Country:US
Mailing Address - Phone:505-453-0643
Mailing Address - Fax:
Practice Address - Street 1:3807 ATRISCO DR NW
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4907
Practice Address - Country:US
Practice Address - Phone:505-615-3487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist