Basic Information
| Provider Information | |||||||||
| NPI: | 1699141838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | STANLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6853 NW 4TH CT | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333177569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163036829 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2950 CLEVELAND CLINIC BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546895000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 30710 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.