Healthcare Provider Details

I. General information

NPI: 1659316404
Provider Name (Legal Business Name): MICHAEL SAUTTER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY 100
MARINA DEL REY CA
90292-5423
US

IV. Provider business mailing address

6029 BRISTOL PKWY 100
CULVER CITY CA
90230-6643
US

V. Phone/Fax

Practice location:
  • Phone: 310-656-1770
  • Fax: 310-578-5379
Mailing address:
  • Phone: 310-417-5901
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: