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NPI Code Detail

MEDICARE: MR. CEZARIO GUTIERREZ JR PT

MEDICARE: MR. CEZARIO GUTIERREZ JR PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070013002IL

General Provider Information

NPI Number : 1194978817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CEZARIO GUTIERREZ JR PT
Provider Business Mailing Address
First Line : 404 BROOKVIEW DR
Second Line :
City : FARMER CITY
State : IL
Zip : 61842-9746
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 404 BROOKVIEW DR
Second Line :
City : FARMER CITY
State : IL
Zip : 61842-9746
Country : US
Telephone Number : 309-928-2118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2008
Last Update Date : 10/25/2008

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