Provider Demographics
NPI:1295879153
Name:GUTIERREZ, DAVID CHRISTIAN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTIAN
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-7717
Mailing Address - Country:US
Mailing Address - Phone:352-426-4063
Mailing Address - Fax:352-465-5033
Practice Address - Street 1:570 W NEWBURY ST
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-7717
Practice Address - Country:US
Practice Address - Phone:352-426-4063
Practice Address - Fax:352-465-5033
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT23157OtherPHYSICAL THERAPIST