Provider Demographics
NPI:1649569716
Name:SUTER, LAURIE (PTA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SUTER
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 1:13601 PINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-9450
Mailing Address - Country:US
Mailing Address - Phone:303-647-0092
Mailing Address - Fax:303-424-9509
Practice Address - Street 1:13601 PINE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:CO
Practice Address - Zip Code:80135-9450
Practice Address - Country:US
Practice Address - Phone:303-647-0092
Practice Address - Fax:303-424-9509
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3386225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant