Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070.016378 | IL |
NPI | 1336403179 |
---|---|
Provider Name | Barbara M Gutierrez |
First Address | Rockford, IL 61108-2381 |
Second Address | Rockford, IL 61108-2381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 26/06/2012 |