Provider Demographics
NPI:1770199374
Name:NUTT, STEVIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:STEVIE
Middle Name:
Last Name:NUTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23836 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3114
Mailing Address - Country:US
Mailing Address - Phone:805-424-6441
Mailing Address - Fax:
Practice Address - Street 1:23836 GILMORE ST
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3114
Practice Address - Country:US
Practice Address - Phone:805-424-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist