Provider Demographics
NPI:1598017345
Name:FIRTH - GUTZ, PHYLLIS ELAINE (LMT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ELAINE
Last Name:FIRTH - GUTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9146 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-9528
Mailing Address - Country:US
Mailing Address - Phone:171-632-6662
Mailing Address - Fax:
Practice Address - Street 1:9146 E LAKE RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-9528
Practice Address - Country:US
Practice Address - Phone:171-632-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMSG001950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist