Provider Demographics
NPI:1205185311
Name:GUTIERREZ, GUSTAVO JR (PT)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 NW 72 AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-888-6959
Mailing Address - Fax:305-593-2517
Practice Address - Street 1:7911 NW 72 AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-888-6959
Practice Address - Fax:305-593-2517
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist