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General NPI Number Information
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NPI Number | 1194391458
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Entity Type | Individual
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Provider Name | RYLEE SUTTON PTA
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 1235 INDIANA CT STE 107
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City | REDLANDS
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State | CA
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Zip | 92374-4540
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Country | US
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Telephone | 909-566-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 25769 VAN LEUVEN ST APT 86
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City | LOMA LINDA
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State | CA
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Zip | 92354-2545
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Country | US
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Telephone | 509-301-9420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 51096
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License Number State | CA
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