Healthcare Provider Details

I. General information

NPI: 1649569716
Provider Name (Legal Business Name): LAURIE SUTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 PINE CREEK RD
SEDALIA CO
80135-9450
US

IV. Provider business mailing address

13601 PINE CREEK RD
SEDALIA CO
80135-9450
US

V. Phone/Fax

Practice location:
  • Phone: 303-647-0092
  • Fax: 303-424-9509
Mailing address:
  • Phone: 303-647-0092
  • Fax: 303-424-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 3386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: