Provider Demographics
NPI:1467826644
Name:SUTTON, RICHARD (CMT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SUTTON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2630
Mailing Address - Country:US
Mailing Address - Phone:231-633-5671
Mailing Address - Fax:231-929-7191
Practice Address - Street 1:615 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2630
Practice Address - Country:US
Practice Address - Phone:231-633-5671
Practice Address - Fax:231-929-7191
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist