MEDICARE: PROF. LAUREL L CLUTE 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	0693	NH

General Provider Information

NPI Number	:	1811964851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. LAUREL L CLUTE PT

Provider Business Mailing Address
First Line	:	700 ROUTE 10
Second Line	:
City	:	EAST LEMPSTER
State	:	NH
Zip	:	03605
Country	:	US
Telephone Number	:	603-863-9049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 COLLEGE DR
Second Line	:	NEW HAMPSHIRE COMMUNITY TECHNICAL COLLEGE
City	:	CLAREMONT
State	:	NH
Zip	:	03743-9707
Country	:	US
Telephone Number	:	603-542-7744
Fax Number	:	603-543-1844

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/08/2007

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