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NPI Code Detail

MEDICARE: MRS. KIMBERLY ANN CAUCUTT PTA

MEDICARE: MRS. KIMBERLY ANN CAUCUTT PTA
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
1225200000XPhysical Therapy Assistant919019WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366656654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY ANN CAUCUTT PTA
Provider Business Mailing Address
First Line : PO BOX 212
Second Line :
City : WATERTOWN
State : WI
Zip : 53094-0212
Country : US
Telephone Number : 920-248-9727
Fax Number :
Provider Business Practice Location Address
First Line : 901 MULBERRY ST
Second Line :
City : LAKE MILLS
State : WI
Zip : 53551-1335
Country : US
Telephone Number : 920-648-8344
Fax Number : 920-648-3441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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