Provider Demographics
NPI:1932290665
Name:SUTPHIN, BRANDEE PAIGE (PT)
Entity Type:Individual
Prefix:
First Name:BRANDEE
Middle Name:PAIGE
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5766 BRONX AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-925-8273
Mailing Address - Fax:941-925-9027
Practice Address - Street 1:5766 BRONX AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231
Practice Address - Country:US
Practice Address - Phone:941-925-8273
Practice Address - Fax:941-925-9027
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT18933OtherST LIC
FLPT18933OtherST LIC