Provider Demographics
NPI:1477808608
Name:GUTIERREZ, DULCE I (PTA)
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:I
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 1:7374 NW 35TH TER
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1241
Mailing Address - Country:US
Mailing Address - Phone:305-326-2674
Mailing Address - Fax:305-418-8997
Practice Address - Street 1:7374 NW 35TH TER
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1241
Practice Address - Country:US
Practice Address - Phone:305-326-2674
Practice Address - Fax:305-418-8997
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26214225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA26214OtherPHYSICAL THERAPY ASSITANT