=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043177785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CUTTER BERGMAN RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8110 E 32ND ST N STE 170
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-330-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10850 COPPER CREEK TRL APT 6205
-----------------------------------------------------
City | MAIZE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67101-9337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-624-0256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 161639
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------