Provider Demographics
NPI:1194391458
Name:SUTTON, RYLEE (PTA)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25769 VAN LEUVEN ST APT 86
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2545
Mailing Address - Country:US
Mailing Address - Phone:509-301-9420
Mailing Address - Fax:
Practice Address - Street 1:1235 INDIANA CT STE 107
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4540
Practice Address - Country:US
Practice Address - Phone:909-566-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51096225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty