Provider Demographics
NPI:1396013371
Name:SHUTE, SARAH (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SHUTE
Suffix:
Gender:F
Credentials:ATC, LAT
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 15400
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011-0556
Mailing Address - Country:US
Mailing Address - Phone:928-523-4152
Mailing Address - Fax:928-523-8464
Practice Address - Street 1:1701 N SAN FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1348
Practice Address - Country:US
Practice Address - Phone:928-523-4152
Practice Address - Fax:928-523-8464
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer