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General NPI Number Information
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NPI Number | 1265791578
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Entity Type | Organization
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Legal Business Name | GUTMAN BACK INSTITUTE, LLC
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 301 N FERNCREEK AVE
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City | ORLANDO
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State | FL
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Zip | 32803-5400
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Country | US
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Telephone | 407-427-1855
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Fax | 407-427-1844
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Provider Business Mailing Address
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Address Line | 3208 E COLONIAL DR 208
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City | ORLANDO
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State | FL
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Zip | 32803-5127
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Country | US
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Telephone | 407-427-1855
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Fax | 407-427-1844
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT GUTMAN
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Credential |
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Telephone | 407-427-1855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | FL
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