Provider Demographics
NPI:1891125308
Name:GUTIERREZ, NOEL
Entity Type:Individual
Prefix:
First Name:NOEL
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 1:2700 SUNRISE RD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-9323
Mailing Address - Country:US
Mailing Address - Phone:512-388-1528
Mailing Address - Fax:512-388-1528
Practice Address - Street 1:2700 SUNRISE RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-9323
Practice Address - Country:US
Practice Address - Phone:512-388-1528
Practice Address - Fax:512-388-1528
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11297322251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics