Provider Demographics
NPI:1811918857
Name:NUTILE, STACEY M (DPT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:NUTILE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ELAINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2748
Mailing Address - Country:US
Mailing Address - Phone:781-443-2616
Mailing Address - Fax:978-655-1160
Practice Address - Street 1:3 ELAINE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2748
Practice Address - Country:US
Practice Address - Phone:781-443-2616
Practice Address - Fax:978-655-1160
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393853Medicaid
ME432037999OtherMAINECARE
NH6107601OtherCIGNA
NH08Y008937NH01OtherANTHEM
NH386489OtherMVP
NH386489OtherMVP