Provider Demographics
NPI:1609545953
Name:GUTIERREZ, CARMEN NICHOLE FALCON (PTA)
Entity Type:Individual
Prefix:
First Name:CARMEN NICHOLE
Middle Name:FALCON
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 1:6360 VILLAGE CLB
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5736
Mailing Address - Country:US
Mailing Address - Phone:830-374-7557
Mailing Address - Fax:
Practice Address - Street 1:5962 DANNY KAYE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5221
Practice Address - Country:US
Practice Address - Phone:210-233-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2160298225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant