Healthcare Provider Details

I. General information

NPI: 1750559647
Provider Name (Legal Business Name): ALISON NICOLE MCCUTCHEON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GLENWOOD DR
MOORESVILLE NC
28115-2876
US

IV. Provider business mailing address

133 FESPERMAN CIR
TROUTMAN NC
28166-3401
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-7494
  • Fax:
Mailing address:
  • Phone: 304-896-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberPTA 001124
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA80235374
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: