Provider Demographics
NPI:1962674879
Name:SUTTON, DIANA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 SE LEGACY COVE CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7631
Mailing Address - Country:US
Mailing Address - Phone:772-214-0833
Mailing Address - Fax:
Practice Address - Street 1:1255 SW THELMA ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3366
Practice Address - Country:US
Practice Address - Phone:772-214-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist