MEDICARE: KELLI DAWN CUTSHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1133486	TX

General Provider Information

NPI Number	:	1235263476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI DAWN CUTSHALL

Provider Business Mailing Address
First Line	:	7316 SUMMERSET DR
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-4537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5312 TRAIL LAKE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1931
Country	:	US
Telephone Number	:	817-263-3041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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Directions to “ KELLI DAWN CUTSHALL ” Practice Location

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