Healthcare Provider Details

I. General information

NPI: 1629430657
Provider Name (Legal Business Name): SAGE HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 SOUTHPOINT PKWY
FREDERICKSBURG VA
22407-2659
US

IV. Provider business mailing address

3522 MISSOURI AVE
RICHMOND VA
23222-2942
US

V. Phone/Fax

Practice location:
  • Phone: 540-891-1186
  • Fax:
Mailing address:
  • Phone: 860-558-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305210676
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: