Provider Demographics
NPI:1457544215
Name:GUTIRREZ, KATHRYN M (PTA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:GUTIRREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N315 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2925
Mailing Address - Country:US
Mailing Address - Phone:630-890-3833
Mailing Address - Fax:
Practice Address - Street 1:0N315 EASTON AVE
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2925
Practice Address - Country:US
Practice Address - Phone:630-890-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant