Provider Demographics
NPI:1073071692
Name:CUTLIP, ERIC R (PTA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:CUTLIP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:GENESEE
Mailing Address - State:ID
Mailing Address - Zip Code:83832-8709
Mailing Address - Country:US
Mailing Address - Phone:208-874-2716
Mailing Address - Fax:
Practice Address - Street 1:104 W ASH ST
Practice Address - Street 2:
Practice Address - City:GENESEE
Practice Address - State:ID
Practice Address - Zip Code:83832-8709
Practice Address - Country:US
Practice Address - Phone:208-874-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-4609225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant