Provider Demographics
NPI:1720312689
Name:LUTTER, CLOVER
Entity Type:Individual
Prefix:
First Name:CLOVER
Middle Name:
Last Name:LUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 FERRY ST
Mailing Address - Street 2:APT D
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3401
Mailing Address - Country:US
Mailing Address - Phone:530-355-6123
Mailing Address - Fax:
Practice Address - Street 1:2910 VEDA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3207
Practice Address - Country:US
Practice Address - Phone:530-355-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist