Healthcare Provider Details

I. General information

NPI: 1710125026
Provider Name (Legal Business Name): PAUL POUTOUVES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 12/20/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W JOHNSON AVE STE 21
CHESHIRE CT
06410-4505
US

IV. Provider business mailing address

149 JUBILEE DR
PLANTSVILLE CT
06479-1029
US

V. Phone/Fax

Practice location:
  • Phone: 516-351-6224
  • Fax:
Mailing address:
  • Phone: 516-351-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number008498
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8498
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: