MEDICARE: DR. ERNESTO GUTIERREZ JR. PT, DPT

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	225100000X	Physical Therapist	1310052	TX

General Provider Information

NPI Number	:	1851863641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNESTO GUTIERREZ JR. PT, DPT

Provider Business Mailing Address
First Line	:	734 NORTH LOOP
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1043
Country	:	US
Telephone Number	:	713-868-2766
Fax Number	:	713-868-7575

Provider Business Practice Location Address
First Line	:	734 NORTH LOOP
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1043
Country	:	US
Telephone Number	:	713-868-2766
Fax Number	:	713-868-7575

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	11/24/2020

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