Provider Demographics
NPI:1346529401
Name:SUTTI, NATHAN JOSEPH (CO, LPO)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:JOSEPH
Last Name:SUTTI
Suffix:
Gender:M
Credentials:CO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 HARRY HINES BLVD.
Mailing Address - Street 2:SUITE V2.302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9091
Mailing Address - Country:US
Mailing Address - Phone:214-645-8250
Mailing Address - Fax:214-645-8258
Practice Address - Street 1:6011 HARRY HINES BLVD
Practice Address - Street 2:SUITE V2.302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9091
Practice Address - Country:US
Practice Address - Phone:214-645-8250
Practice Address - Fax:214-645-8258
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCO004984222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086893706Medicaid
TX086893706Medicaid