Healthcare Provider Details

I. General information

NPI: 1912733353
Provider Name (Legal Business Name): KYLENE SUTTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 25TH AVE NE STE 201
SEATTLE WA
98105-4152
US

IV. Provider business mailing address

9536 INTERLAKE AVE N
SEATTLE WA
98103-3324
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-6702
  • Fax:
Mailing address:
  • Phone: 509-304-4583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61594597
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: