Provider Demographics
NPI:1215214119
Name:GUTIERREZ, BERTHA A (PTA)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12159 ALEX GUERRERO CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0921
Mailing Address - Country:US
Mailing Address - Phone:915-820-5755
Mailing Address - Fax:
Practice Address - Street 1:12159 ALEX GUERRERO CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0921
Practice Address - Country:US
Practice Address - Phone:915-820-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2074973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant