Healthcare Provider Details

I. General information

NPI: 1043272560
Provider Name (Legal Business Name): ANNE C GUTIERREZ MS, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 ELROD AVE
QUANTICO VA
22134-5113
US

IV. Provider business mailing address

12433 MAYS QUARTER RD
WOODBRIDGE VA
22192-5478
US

V. Phone/Fax

Practice location:
  • Phone: 703-432-6536
  • Fax:
Mailing address:
  • Phone: 806-549-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003868
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: