Provider Demographics
NPI:1144656620
Name:GUTIERREZ, SIMRAN (PT)
Entity type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SIMRAN
Other - Middle Name:
Other - Last Name:BAKSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 S OLD HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 S OLD HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5310
Practice Address - Country:US
Practice Address - Phone:512-504-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist