Provider Demographics
NPI:1053791723
Name:ORCUTT, REX
Entity type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:ORCUTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46502-0026
Mailing Address - Country:US
Mailing Address - Phone:574-371-7400
Mailing Address - Fax:
Practice Address - Street 1:2626 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3800
Practice Address - Country:US
Practice Address - Phone:574-371-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20900838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist