Basic Information
| Provider Information | |||||||||
| NPI: | 1205174711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLUTTER | ||||||||
| FirstName: | DONALD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 MESA VIEW DR | ||||||||
| Address2: | # 240 | ||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934205548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606947409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 784 HIGH STREET | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055406500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2013 | ||||||||
| LastUpdateDate: | 10/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | PT15664 | CA | N | Nursing Service Related Providers | Technician | 167G00000X | PT15664 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.