Provider Demographics
NPI:1336721588
Name:MCCUTCHAN, BENJAMIN CURTIS (PTA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CURTIS
Last Name:MCCUTCHAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CHRISTINE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3414
Mailing Address - Country:US
Mailing Address - Phone:314-315-7005
Mailing Address - Fax:
Practice Address - Street 1:88 CHRISTINE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3414
Practice Address - Country:US
Practice Address - Phone:314-315-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004637225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant