Provider Demographics
NPI:1982627477
Name:SUTTON, LISA LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 TAMALPAIS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1736
Mailing Address - Country:US
Mailing Address - Phone:415-706-0416
Mailing Address - Fax:
Practice Address - Street 1:770 TAMALPAIS DR STE 203
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1736
Practice Address - Country:US
Practice Address - Phone:415-706-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist