Provider Demographics
NPI:1174722938
Name:GUTIERREZ, CARLA (PT)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2066
Mailing Address - Country:US
Mailing Address - Phone:956-206-9648
Mailing Address - Fax:
Practice Address - Street 1:414 SHILOH DR
Practice Address - Street 2:SUITE 9
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6744
Practice Address - Country:US
Practice Address - Phone:956-791-8235
Practice Address - Fax:956-791-8239
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174650OtherTX BOARD OF PT EXAMINERS