Provider Demographics
NPI:1194793034
Name:CLOUTIER, GREGGORY PATRICK (AT,C)
Entity type:Individual
Prefix:MR
First Name:GREGGORY
Middle Name:PATRICK
Last Name:CLOUTIER
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 WRIGHT SPUR RD
Mailing Address - Street 2:
Mailing Address - City:TOOMSUBA
Mailing Address - State:MS
Mailing Address - Zip Code:39364-9716
Mailing Address - Country:US
Mailing Address - Phone:601-632-5874
Mailing Address - Fax:
Practice Address - Street 1:2320 32ND ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-4657
Practice Address - Country:US
Practice Address - Phone:601-553-2169
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT00202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer