Healthcare Provider Details

I. General information

NPI: 1164708012
Provider Name (Legal Business Name): MR. ERIC CUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 LORA MEADOWS CT
SPRING TX
77386-4060
US

IV. Provider business mailing address

1903 LORA MEADOWS CT
SPRING TX
77386-4060
US

V. Phone/Fax

Practice location:
  • Phone: 727-534-5612
  • Fax:
Mailing address:
  • Phone: 727-534-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2066928
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: