Healthcare Provider Details

I. General information

NPI: 1043789738
Provider Name (Legal Business Name): STEVEN C HUTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2018
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DEMING ST
SOUTH WINDSOR CT
06074-3759
US

IV. Provider business mailing address

580 W MONTAUK HWY
WEST BABYLON NY
11704-8307
US

V. Phone/Fax

Practice location:
  • Phone: 860-432-2911
  • Fax:
Mailing address:
  • Phone: 631-278-0665
  • Fax: 631-549-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number6213
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: