Provider Demographics
NPI:1275656142
Name:CALCUTT, KAREN TATUM (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:TATUM
Last Name:CALCUTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7254 PELLINORE DR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9212
Mailing Address - Country:US
Mailing Address - Phone:336-945-4088
Mailing Address - Fax:
Practice Address - Street 1:1240 ARBOR RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1106
Practice Address - Country:US
Practice Address - Phone:336-724-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC193225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant