Provider Demographics
NPI:1508540345
Name:SUTTER, TERESA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:SUTTER
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 1:6368 COVENTRY WAY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-8705
Mailing Address - Country:US
Mailing Address - Phone:419-376-1427
Mailing Address - Fax:
Practice Address - Street 1:6368 COVENTRY WAY
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-8705
Practice Address - Country:US
Practice Address - Phone:419-375-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004506225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant