Provider Demographics
NPI:1508903642
Name:SUTTON, JENNIFER A (MS, PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 EAST BLVD
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1515
Mailing Address - Country:US
Mailing Address - Phone:315-345-1029
Mailing Address - Fax:
Practice Address - Street 1:2300 BUFFALO RD
Practice Address - Street 2:BUILDING 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1360
Practice Address - Country:US
Practice Address - Phone:585-247-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022261-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist