Provider Demographics
NPI:1205467420
Name:SUTTON, BRIAN KEITH
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:SUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 GROVE RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4630
Mailing Address - Country:US
Mailing Address - Phone:864-233-5128
Mailing Address - Fax:
Practice Address - Street 1:2021 BRIDGEMILL DR
Practice Address - Street 2:STE 106
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707
Practice Address - Country:US
Practice Address - Phone:803-298-8995
Practice Address - Fax:803-620-4670
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist