MEDICARE: DAVID CHRISTIAN GUTIERREZ

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	PT23157	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT23157	OTHER	FL	PHYSICAL THERAPIST

General Provider Information

NPI Number	:	1295879153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CHRISTIAN GUTIERREZ

Provider Business Mailing Address
First Line	:	570 W NEWBURY ST
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-7717
Country	:	US
Telephone Number	:	352-426-4063
Fax Number	:	352-465-5033

Provider Business Practice Location Address
First Line	:	570 W NEWBURY ST
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-7717
Country	:	US
Telephone Number	:	352-426-4063
Fax Number	:	352-465-5033

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/28/2012

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