Provider Demographics
NPI:1508912791
Name:SUTTON, THOMAS LEE (DPT, PT, CSCS,HFI)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DPT, PT, CSCS,HFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PRUITT RD
Mailing Address - Street 2:#1023
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3021
Mailing Address - Country:US
Mailing Address - Phone:818-795-8131
Mailing Address - Fax:
Practice Address - Street 1:602 PRUITT ROAD
Practice Address - Street 2:TEKTONIC ATHLETIC DEVELOPMENT
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386
Practice Address - Country:US
Practice Address - Phone:832-482-9635
Practice Address - Fax:832-220-8007
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29577225100000X, 2251N0400X, 2251S0007X, 2251X0800X
TX1175929225100000X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic