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General NPI Number Information
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NPI Number | 1104487081
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Entity Type | Individual
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Provider Name | CARRIE ANN GUTIERREZ PTA
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Gender | Female
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Dates
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Enumeration Date | 06/22/2019
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Last Update Date | 06/22/2019
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Provider Practice Location Address
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Address Line | 16219 RANCH ROAD 620 N
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City | AUSTIN
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State | TX
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Zip | 78717-5209
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Country | US
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Telephone | 512-520-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 307 INTERNATIONAL CIR STE 100
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-1387
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Country | US
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Telephone | 201-470-2846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2036515
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License Number State | TX
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