Provider Demographics
NPI:1861968703
Name:GUTIERREZ, ENRICO PAULO R (DPT)
Entity type:Individual
Prefix:
First Name:ENRICO PAULO
Middle Name:R
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 POTTER AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7622
Mailing Address - Country:US
Mailing Address - Phone:908-400-0427
Mailing Address - Fax:
Practice Address - Street 1:948 POTTER AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7622
Practice Address - Country:US
Practice Address - Phone:908-400-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01659000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist