Provider Demographics
NPI:1417108788
Name:GUTTERMAN, MICHELE RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:GUTTERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:RENEE
Other - Last Name:GUTTERMAN HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:263 HERONWOOD CIRLCE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-9426
Mailing Address - Country:US
Mailing Address - Phone:386-575-0478
Mailing Address - Fax:
Practice Address - Street 1:201 NORTH CLYDE MORRIS BOULEVARD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-254-4001
Practice Address - Fax:386-947-4645
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist