MEDICARE: KENNER GUTIERREZ MA

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
1	225700000X	Massage Therapist	MA 64023	FL
2	225200000X	Physical Therapy Assistant	PTA26844	FL

General Provider Information

NPI Number	:	1740558584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNER GUTIERREZ MA

Provider Business Mailing Address
First Line	:	13595 SW 134TH AVE STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4580
Country	:	US
Telephone Number	:	786-218-7690
Fax Number	:	305-259-6778

Provider Business Practice Location Address
First Line	:	13595 SW 134TH AVE STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4580
Country	:	US
Telephone Number	:	786-218-7690
Fax Number	:	305-259-6778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	03/21/2024

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Directions to “ KENNER GUTIERREZ MA” Practice Location

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