Provider Demographics
NPI:1033284237
Name:GUTIERREZ, ALLAN ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:ANTHONY
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STIRLING CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8307
Mailing Address - Country:US
Mailing Address - Phone:845-787-0440
Mailing Address - Fax:845-928-4796
Practice Address - Street 1:117 EXECUTIVE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5503
Practice Address - Country:US
Practice Address - Phone:845-787-0440
Practice Address - Fax:845-787-0441
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016020208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation