Provider Demographics
NPI:1356305460
Name:MCCUTCHEN, CLAUDIA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:CLAUDIA
Middle Name:
Last Name:MCCUTCHEN
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 1:200 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-394-7000
Mailing Address - Fax:870-394-7001
Practice Address - Street 1:200 W BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-394-7000
Practice Address - Fax:870-394-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150160721Medicaid