Provider Demographics
NPI:1780646703
Name:SUTTON, TISHA DAWN (MPT)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:DAWN
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:PSC 9 BOX 5936
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123-0060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52ND MDG/SPANGDAHLEM CLINIC
Practice Address - Street 2:BUILDING 550
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09123
Practice Address - Country:US
Practice Address - Phone:314-452-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic