Provider Demographics
NPI:1851535249
Name:COUTU, DOUGLAS J
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:COUTU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HURON ST
Mailing Address - Street 2:#4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6010
Mailing Address - Country:US
Mailing Address - Phone:804-814-7777
Mailing Address - Fax:
Practice Address - Street 1:180 HURON ST
Practice Address - Street 2:#4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6010
Practice Address - Country:US
Practice Address - Phone:804-814-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022076-1225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner