Healthcare Provider Details

I. General information

NPI: 1013214857
Provider Name (Legal Business Name): VALERIE A GUTIERREZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 05/14/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 HWY 346
BOSQUE NM
87006
US

IV. Provider business mailing address

575 CAMINO DE HIGINO
LOS LUNAS NM
87031-9356
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-3451
  • Fax:
Mailing address:
  • Phone: 505-450-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3920
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: