Provider Demographics
NPI:1275722787
Name:CLOUTIER, STEWART EDWARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:EDWARD
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3154
Mailing Address - Country:US
Mailing Address - Phone:603-627-2816
Mailing Address - Fax:
Practice Address - Street 1:344 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3154
Practice Address - Country:US
Practice Address - Phone:603-627-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-21
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0212390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program