Provider Demographics
NPI:1811109754
Name:FAUTEUX, STEPHEN LEE (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:FAUTEUX
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 1:35 SANBORN DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3402
Mailing Address - Country:US
Mailing Address - Phone:603-579-4794
Mailing Address - Fax:
Practice Address - Street 1:769 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5166
Practice Address - Country:US
Practice Address - Phone:603-641-6700
Practice Address - Fax:603-623-3611
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist