Provider Demographics
NPI:1093546137
Name:GUTIERREZ, DALFRY JAVIER (PT, DPT)
Entity type:Individual
Prefix:
First Name:DALFRY
Middle Name:JAVIER
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PT, DPT
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 189TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4322
Mailing Address - Country:US
Mailing Address - Phone:347-805-7170
Mailing Address - Fax:
Practice Address - Street 1:51 AUDUBON AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2248
Practice Address - Country:US
Practice Address - Phone:212-304-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist