Provider Demographics
NPI:1679535801
Name:COUTU, ROBERT GORDON (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GORDON
Last Name:COUTU
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 N EVERLASTING DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 SE 17TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9144
Practice Address - Country:US
Practice Address - Phone:352-629-4509
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 1833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist