Provider Demographics
NPI:1326183856
Name:LAUTIERI, DEREK ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ANDREW
Last Name:LAUTIERI
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 1:20A RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4919
Mailing Address - Country:US
Mailing Address - Phone:603-669-4524
Mailing Address - Fax:603-641-9206
Practice Address - Street 1:2108 RIVER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-1302
Practice Address - Country:US
Practice Address - Phone:603-669-4524
Practice Address - Fax:603-641-9206
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist