MEDICARE: MR. JAN CLARENCE GUTIERREZ DIMLA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070022794	IL

General Provider Information

NPI Number	:	1215455027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAN CLARENCE GUTIERREZ DIMLA PT

Provider Business Mailing Address
First Line	:	702 LURIA LN
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1107
Country	:	US
Telephone Number	:	217-550-9634
Fax Number	:

Provider Business Practice Location Address
First Line	:	14792 CATLIN TILTON RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-5116
Country	:	US
Telephone Number	:	217-443-6430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	08/31/2017

Similar Medicare Providers

1922197383 — COUNTY OF VERMILION
Practice Location Address:

14792 CATLIN TILTON RD
DANVILLE, IL
61834-5116

Practice Phone: 217-443-6430
Practice Fax: 217-443-1558

1487830980 — MS. GEORGE ANNE HUME LCSW
Practice Location Address:

14792 CATLIN TILTON RD
DANVILLE, IL
61834-5116

Practice Phone: 217-443-6430
Practice Fax: 217-443-1558

1407093594 — MS. JENNIFER SALAZAR PIDO PT
Practice Location Address:

14792 CATLIN TILTON RD
DANVILLE, IL
61834-5116

Practice Phone: 217-443-6430
Practice Fax: 217-443-1558

1336763358 — BURGANDY D HENDERSON
Practice Location Address:

14792 CATLIN TILTON RD
DANVILLE, IL
61834-5116

Practice Phone: 217-443-6430
Practice Fax:

1356958565 — MR. KENNETH NEAL HAWKER JR. FNP
Practice Location Address:

136 CAPRI CT
DANVILLE, VA
24541-5116

Practice Phone: 434-334-2706
Practice Fax:

1780601070 — WALMART INC.
Practice Location Address:

4101 N VERMILION ST STE A
DANVILLE, IL
61834-5997

Practice Phone: 217-443-9587
Practice Fax:

Directions to “ MR. JAN CLARENCE GUTIERREZ DIMLA PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.