MEDICARE: GEORGETTE CONSTANCE SUTTMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	MT102660	TX

General Provider Information

NPI Number	:	1194060590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGETTE CONSTANCE SUTTMAN

Provider Business Mailing Address
First Line	:	1571 W SAM HOUSTON PKWY S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2904
Country	:	US
Telephone Number	:	832-512-7858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1571 W SAM HOUSTON PKWY S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2904
Country	:	US
Telephone Number	:	832-512-7858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/11/2012

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Directions to “ GEORGETTE CONSTANCE SUTTMAN ” Practice Location

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