Provider Demographics
NPI:1184968372
Name:SUTTON, CASSANDRA ANN (PTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0002
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:834 N SOCORA ST
Practice Address - Street 2:STE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3279
Practice Address - Country:US
Practice Address - Phone:316-440-3731
Practice Address - Fax:316-440-3741
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02439225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant