MEDICARE: MS. GRISELLE GUTIERREZ MHSA, RHIA, 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	479	PR

General Provider Information

NPI Number	:	1306051966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRISELLE GUTIERREZ MHSA, RHIA, PT

Provider Business Mailing Address
First Line	:	PLAZA INMACULADA #I, APT. 1404, PONCE DE LEON 1717
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909
Country	:	US
Telephone Number	:	787-728-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 AVE PONCE DE LEON
Second Line	:	APT 1404
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1924
Country	:	US
Telephone Number	:	787-728-3368
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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