Provider Demographics
NPI:1558489146
Name:SUTTLES, JONATHAN THOMAS (MSPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:THOMAS
Last Name:SUTTLES
Suffix:
Gender:M
Credentials:MSPT
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 2689
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2689
Mailing Address - Country:US
Mailing Address - Phone:509-260-1051
Mailing Address - Fax:888-538-7694
Practice Address - Street 1:722 E UNIVERSITY WAY
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-2947
Practice Address - Country:US
Practice Address - Phone:509-962-1553
Practice Address - Fax:509-962-1554
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA162229OtherLABOR & INDUSTRIES
WA8344749Medicaid
WA98725SUOtherREGENCE BLUE SHIELD
WAAB34175Medicare ID - Type Unspecified