Provider Demographics
NPI:1902997000
Name:GUTIERREZ, GUS LUIS (PT, DPT,OCS, FAAOMPT)
Entity Type:Individual
Prefix:MR
First Name:GUS
Middle Name:LUIS
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PT, DPT,OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 WEST ST. CLARE BLVD
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-743-2060
Mailing Address - Fax:225-743-2065
Practice Address - Street 1:1014 WEST ST. CLARE BLVD
Practice Address - Street 2:SUITE 1050
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-743-2060
Practice Address - Fax:225-743-2065
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic