Provider Demographics
NPI:1528394012
Name:SUTTON, STEPHEN MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:SUTTON
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:2804 N OAK ST
Mailing Address - Street 2:STE C
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5913
Mailing Address - Country:US
Mailing Address - Phone:229-257-7393
Mailing Address - Fax:229-329-4349
Practice Address - Street 1:3278 MITCHELL BLVD
Practice Address - Street 2:23D MEDICAL GROUP
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699-1500
Practice Address - Country:US
Practice Address - Phone:229-257-7393
Practice Address - Fax:229-329-4349
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2018-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT002160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I654505Medicare PIN