Provider Demographics
NPI:1245480177
Name:GUTIERREZ, AMANDA MICHELE (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELE
Other - Last Name:SHUFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4-901 KUHIO HWY STE B
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1549
Mailing Address - Country:US
Mailing Address - Phone:808-826-6000
Mailing Address - Fax:844-965-9830
Practice Address - Street 1:4-901 KUHIO HWY STE B
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1549
Practice Address - Country:US
Practice Address - Phone:808-826-6000
Practice Address - Fax:844-965-9830
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11895082251X0800X
MI55010136842251X0800X
HI57432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236742OtherMEDICARE
TX206938701Medicaid
MI30696OtherBCBS FACILITY ID
TX206938701Medicaid