MEDICARE: ALEXANDRA GUTMAN MPT

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	34136	CA

General Provider Information

NPI Number	:	1922261023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GUTMAN MPT

Provider Business Mailing Address
First Line	:	1017 N SPAULDING AVE
Second Line	:	APT 1
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6238
Country	:	US
Telephone Number	:	310-467-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 N SPAULDING AVE
Second Line	:	APT 1
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6238
Country	:	US
Telephone Number	:	310-467-1919
Fax Number	:

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	02/08/2013

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