Healthcare Provider Details

I. General information

NPI: 1396378485
Provider Name (Legal Business Name): MELISSA GUTHEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HULL RD
GAINESVILLE FL
32607-4144
US

IV. Provider business mailing address

4400 SW 20TH AVE APT 2116
GAINESVILLE FL
32607-3902
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: