Victor Cutillo, DPT
Individual provider Active NPI Physical Therapist · Shelbyville, TN
NPI 1881233799 · NPPES record last updated Dec 26, 2019
Key facts
- NPI
- 1881233799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12429 (TN)
- Practice address
- 105 Northside Park Dr
Shelbyville, TN 37160-2062 - Phone
- (931) 735-6451
- Fax
- (931) 735-6453
- NPI assigned
- Dec 26, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1300 W Sam Houston Pkwy S
Suite 300
Houston, TX 77042-2453
PO Box
Franklin, TN 37068
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250519000300 | TN | Practitioner - Physical Therapist in Private Practice | 6709268329 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12429 | TN | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12429 | TN | Yes |
Addresses
Primary practice location
105 Northside Park Dr
Shelbyville, TN 37160-2062
Mailing address
PO Box 681478
Franklin, TN 37068-1478
Phone (615) 591-6590
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0446631 | Medicaid | TN |
NPI Registry JSON
{
"created_epoch": "1577318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577318400000",
"number": "1881233799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 681478",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370681478",
"telephone_number": "615-591-6590",
"fax_number": "615-591-6601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 NORTHSIDE PARK DR",
"city": "SHELBYVILLE",
"state": "TN",
"postal_code": "371602062",
"telephone_number": "931-735-6451",
"fax_number": "931-735-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUTILLO",
"first_name": "VICTOR",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-26",
"last_updated": "2019-12-26",
"certification_date": "2019-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "12429",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0446631",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelbyville, TN
- Warren David Craft
- Tracy Crenshaw
- Jena Annice Cunningham
- Shelby Lynn Cunningham
- Graciela Lopez Curtis
- Cutting Edge Optical, LLC
- Dale Hasty
- Brooke Dangerfield
- Jeff Daugherty
- Susan Kinard Davenport
All providers in Shelbyville, TN · Physical Therapist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.