Provider Demographics
NPI:1306051966
Name:GUTIERREZ, GRISELLE (MHSA, RHIA, PT)
Entity type:Individual
Prefix:MS
First Name:GRISELLE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MHSA, RHIA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA INMACULADA #I, APT. 1404, PONCE DE LEON 1717
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-728-3368
Mailing Address - Fax:
Practice Address - Street 1:1717 AVE PONCE DE LEON
Practice Address - Street 2:APT 1404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1924
Practice Address - Country:US
Practice Address - Phone:787-728-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist