Provider Demographics
NPI:1013402221
Name:KUTTEROFF, DAVID (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KUTTEROFF
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WAITKUS ALY
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4341
Mailing Address - Country:US
Mailing Address - Phone:609-458-5558
Mailing Address - Fax:
Practice Address - Street 1:25 WRIGHTSTOWN COOKSTOWN RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08562-2341
Practice Address - Country:US
Practice Address - Phone:609-901-3005
Practice Address - Fax:609-723-4250
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01792200225100000X
PADAPT005134225100000X
PAPT029613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist