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General NPI Number Information
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NPI Number | 1790185155
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Entity Type | Individual
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Provider Name | GRANT CUTCHIN ATC
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Gender | Male
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 984B LASKIN RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-3905
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Country | US
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Telephone | 757-395-6900
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Fax | 757-425-7180
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Provider Business Mailing Address
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Address Line | 984B LASKIN RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-3905
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Country | US
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Telephone | 757-395-6900
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Fax | 757-425-7180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002148
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305211892
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License Number State | VA
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