Provider Demographics
NPI:1750559647
Name:MCCUTCHEON, ALISON NICOLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:NICOLE
Last Name:MCCUTCHEON
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 1:133 FESPERMAN CIR
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-3401
Mailing Address - Country:US
Mailing Address - Phone:304-896-4449
Mailing Address - Fax:
Practice Address - Street 1:550 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2876
Practice Address - Country:US
Practice Address - Phone:704-664-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA 001124320700000X
NCPTA80235374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750559647OtherPTA
NC80235374OtherPTA