Provider Demographics
NPI:1528196722
Name:GUTHRIE, CHAD MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 VIDINA DR
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7698
Mailing Address - Country:US
Mailing Address - Phone:321-775-6800
Mailing Address - Fax:
Practice Address - Street 1:2355 VIDINA DR
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7698
Practice Address - Country:US
Practice Address - Phone:321-775-6800
Practice Address - Fax:321-775-4888
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT231582251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884156046Medicaid