Provider Demographics
NPI:1063993764
Name:GUTSCHENRITTER, ALEXA KATE (CPTA)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:KATE
Last Name:GUTSCHENRITTER
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:MRS
Other - First Name:ALEXA
Other - Middle Name:KATE
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-2116
Mailing Address - Country:US
Mailing Address - Phone:719-361-0005
Mailing Address - Fax:
Practice Address - Street 1:629 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1928
Practice Address - Country:US
Practice Address - Phone:620-432-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03433225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14-03433Medicaid