Provider Demographics
NPI:1841891074
Name:GUTIERREZ, KRISTEN (LMT, CNMT, CCT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMT, CNMT, CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11190 SALT CREEK PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4180
Mailing Address - Country:US
Mailing Address - Phone:719-290-5914
Mailing Address - Fax:
Practice Address - Street 1:6270 LEHMAN DR STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1450
Practice Address - Country:US
Practice Address - Phone:719-290-5914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist