Provider Demographics
NPI:1659316404
Name:SAUTTER, MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SAUTTER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6029 BRISTOL PKWY
Mailing Address - Street 2:100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6643
Mailing Address - Country:US
Mailing Address - Phone:310-417-5901
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:100
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-656-1770
Practice Address - Fax:310-578-5379
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT19100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1460FMedicare PIN