Provider Demographics
NPI:1114139466
Name:GUTIERREZ, CARLO RAY BITANGA (PTA)
Entity type:Individual
Prefix:MR
First Name:CARLO RAY
Middle Name:BITANGA
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19631 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6402
Mailing Address - Country:US
Mailing Address - Phone:305-827-2155
Mailing Address - Fax:
Practice Address - Street 1:15344 NW 79TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5850
Practice Address - Country:US
Practice Address - Phone:305-821-0502
Practice Address - Fax:305-362-5209
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant