Provider Demographics
NPI:1972627776
Name:GUTERMUTH, ANGELA MUEGGLER (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MUEGGLER
Last Name:GUTERMUTH
Suffix:
Gender:F
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:PO BOX 2577
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-2577
Mailing Address - Country:US
Mailing Address - Phone:530-623-2318
Mailing Address - Fax:
Practice Address - Street 1:31660 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-2120
Practice Address - Country:US
Practice Address - Phone:530-623-0021
Practice Address - Fax:530-623-0025
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT258620Medicare ID - Type Unspecified