Provider Demographics
NPI:1912152489
Name:CUTOLO, RENATO A (MS,PT)
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:A
Last Name:CUTOLO
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 LUCAS AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-6209
Mailing Address - Country:US
Mailing Address - Phone:845-339-7837
Mailing Address - Fax:
Practice Address - Street 1:817 LUCAS AVENUE EXT
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443-6209
Practice Address - Country:US
Practice Address - Phone:845-339-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012099-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist