Provider Demographics
NPI:1417644683
Name:BOUTIN, SEAN C (LMT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:C
Last Name:BOUTIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1907
Mailing Address - Country:US
Mailing Address - Phone:413-237-9768
Mailing Address - Fax:
Practice Address - Street 1:701 WASHINGTON ST. B2
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-0245
Practice Address - Country:US
Practice Address - Phone:617-244-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-11218-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty