Individual
JASON EDWARD GUTIERRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
414 MAIN STREET, TRUTH OR CONSEQUENCES, NM 87901
(505) 894-7847
(505) 894-7851
Mailing address
414 MAIN STREET, TRUTH OR CONSEQUENCES, NM 87901
(505) 894-7847
(505) 894-7851
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2906
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460753356
—
NM
Enumeration date
08/21/2006
Last updated
05/23/2008
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