Healthcare Provider Details

I. General information

NPI: 1598590952
Provider Name (Legal Business Name): JONATHAN JOSEPH GUTIERREZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE BLDG 7500
FORT CARSON CO
80913
US

IV. Provider business mailing address

2726 TUMBLEWOOD GRV
COLORADO SPRINGS CO
80910-4462
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 312-208-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0014969
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: