Provider Demographics
NPI:1366105900
Name:CUTZ, EUZETTA MAUD (LMT)
Entity type:Individual
Prefix:
First Name:EUZETTA
Middle Name:MAUD
Last Name:CUTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EUZETTA
Other - Middle Name:MAUD
Other - Last Name:SOUMOKIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 NW ADAMS ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3550
Mailing Address - Country:US
Mailing Address - Phone:503-209-0541
Mailing Address - Fax:503-435-2534
Practice Address - Street 1:1300 NW ADAMS ST STE C
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3550
Practice Address - Country:US
Practice Address - Phone:503-209-0541
Practice Address - Fax:503-435-2534
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist