Provider Demographics
NPI:1285696997
Name:SOULIERE, TODD A
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:A
Last Name:SOULIERE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TODD
Other - Middle Name:A
Other - Last Name:SOULIERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, CSCS
Mailing Address - Street 1:380 SQUANTUM RD
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-6646
Mailing Address - Country:US
Mailing Address - Phone:603-532-6301
Mailing Address - Fax:978-665-3803
Practice Address - Street 1:160 PEARL ST
Practice Address - Street 2:FITCHBURG STATE COLLEGE
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-2631
Practice Address - Country:US
Practice Address - Phone:978-665-3774
Practice Address - Fax:978-665-3803
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer