Provider Demographics
NPI:1396728176
Name:CLOUTMAN, ANDREW S (PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:CLOUTMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2838
Mailing Address - Country:US
Mailing Address - Phone:914-478-6344
Mailing Address - Fax:
Practice Address - Street 1:8 AQUEDUCT LANE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533
Practice Address - Country:US
Practice Address - Phone:914-591-4332
Practice Address - Fax:914-591-4338
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019214-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02481189Medicaid
NYQ09A31Medicare ID - Type Unspecified