Provider Demographics
NPI:1700969045
Name:CUTALO, THOMAS (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CUTALO
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HIGHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1503
Mailing Address - Country:US
Mailing Address - Phone:973-571-1875
Mailing Address - Fax:
Practice Address - Street 1:333 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1701
Practice Address - Country:US
Practice Address - Phone:973-470-2524
Practice Address - Fax:973-470-2524
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMT000393002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer