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NPI Code Detail

MEDICARE: MR. VINCENT DAVID GUTIERREZ P.T.

MEDICARE: MR. VINCENT DAVID GUTIERREZ P.T.
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
1225100000XPhysical Therapist070-016294IL

General Provider Information

NPI Number : 1245402601
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VINCENT DAVID GUTIERREZ P.T.
Provider Business Mailing Address
First Line : 18215 HARLEM AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3609
Country : US
Telephone Number : 708-444-2563
Fax Number : 708-444-2769
Provider Business Practice Location Address
First Line : 18215 HARLEM AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3609
Country : US
Telephone Number : 708-444-2563
Fax Number : 708-444-2769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2008
Last Update Date : 03/26/2008

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