MEDICARE: STEPHEN LEE FAUTEUX PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2605	NH

General Provider Information

NPI Number	:	1811109754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN LEE FAUTEUX PT

Provider Business Mailing Address
First Line	:	35 SANBORN DR
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-3402
Country	:	US
Telephone Number	:	603-579-4794
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 S MAIN ST STE 201
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03102-5166
Country	:	US
Telephone Number	:	603-641-6700
Fax Number	:	603-623-3611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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