Provider Demographics
NPI:1194798363
Name:MCCUTCHAN, ERIC DANIEL (MS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DANIEL
Last Name:MCCUTCHAN
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 MCFARRING DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5899
Mailing Address - Country:US
Mailing Address - Phone:574-596-3968
Mailing Address - Fax:
Practice Address - Street 1:9821 MCFARRING DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5899
Practice Address - Country:US
Practice Address - Phone:574-596-3968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 20362255A2300X
IN36001111A2255A2300X
TXAT66882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer