Provider Demographics
NPI:1033340385
Name:SUTTON, SHAWN DUNCAN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DUNCAN
Last Name:SUTTON
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 1:841 W MARION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1031
Mailing Address - Country:US
Mailing Address - Phone:419-946-1980
Mailing Address - Fax:419-946-1757
Practice Address - Street 1:841 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1031
Practice Address - Country:US
Practice Address - Phone:419-946-1980
Practice Address - Fax:419-946-1757
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist