Provider Demographics
NPI:1366862211
Name:GUTHRIE, JOSEPH JR (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GUTHRIE
Suffix:JR
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BULLDOG AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4954
Mailing Address - Country:US
Mailing Address - Phone:409-382-1376
Mailing Address - Fax:
Practice Address - Street 1:400 BULLDOG AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4954
Practice Address - Country:US
Practice Address - Phone:409-382-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT17422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer