Provider Demographics
NPI:1700943727
Name:GUTIERREZ, ALDOLFO (PTA)
Entity Type:Individual
Prefix:
First Name:ALDOLFO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:ALDOLFO
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2805 FOUNTAIN PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8031
Mailing Address - Country:US
Mailing Address - Phone:956-316-2224
Mailing Address - Fax:956-316-0445
Practice Address - Street 1:1403 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8752
Practice Address - Country:US
Practice Address - Phone:956-723-6700
Practice Address - Fax:956-724-5559
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2048148225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2048148OtherPTA