Provider Demographics
NPI:1750477816
Name:GUTHRIE, STEPHEN M (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 MAIN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2789
Mailing Address - Country:US
Mailing Address - Phone:205-608-3113
Mailing Address - Fax:205-608-3036
Practice Address - Street 1:651 MAIN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2789
Practice Address - Country:US
Practice Address - Phone:205-608-3113
Practice Address - Fax:205-608-3036
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890015920Medicaid
AL51003348OtherBCBS AL
AL51003348OtherBCBS AL
AL890015920Medicaid