Provider Demographics
NPI:1578800108
Name:GUTENDORF, STEVEN P (LMT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:P
Last Name:GUTENDORF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 SE FLOSS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5681
Mailing Address - Country:US
Mailing Address - Phone:503-709-2090
Mailing Address - Fax:
Practice Address - Street 1:3225 SE FLOSS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5681
Practice Address - Country:US
Practice Address - Phone:503-709-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19174172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist