Provider Demographics
NPI:1144744012
Name:CUTRONE, SAMANTHA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:CUTRONE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 ROUTE 590
Mailing Address - Street 2:
Mailing Address - City:LACKAWAXEN
Mailing Address - State:PA
Mailing Address - Zip Code:18435-9730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:961 ROUTE 590
Practice Address - Street 2:
Practice Address - City:LACKAWAXEN
Practice Address - State:PA
Practice Address - Zip Code:18435-9730
Practice Address - Country:US
Practice Address - Phone:570-229-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
22Other22
7084651488OtherATHLETIC TRAINER