Provider Demographics
NPI:1740388297
Name:GUTIERREZ, JENNIFER L (MSPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:525 E CHARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4247
Mailing Address - Country:US
Mailing Address - Phone:650-618-3360
Mailing Address - Fax:
Practice Address - Street 1:68 WILLOW RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3653
Practice Address - Country:US
Practice Address - Phone:877-390-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007873225100000X
CAPT41011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8936908OtherCRIME VICTIMS
WA159304OtherDEPT OF LABOR & INDUSTRIE
WA8972GUOtherREGENCE BLUE SHIELD
WA650024224OtherRAILROAD MEDICARE
WAA010OtherTRICARE
WAAB29726Medicare ID - Type UnspecifiedPIERCE COUNTY