Provider Demographics
NPI:1821187618
Name:GUTIERREZ, GUILLERMO
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 S DIXIE HWY
Mailing Address - Street 2:STE 308
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1129
Mailing Address - Country:US
Mailing Address - Phone:305-661-1441
Mailing Address - Fax:305-661-1443
Practice Address - Street 1:8603 S DIXIE HWY
Practice Address - Street 2:STE 308
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1129
Practice Address - Country:US
Practice Address - Phone:305-661-1441
Practice Address - Fax:305-661-1443
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y6105AMedicare ID - Type Unspecified