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NPI Code Detail

MEDICARE: MR. STEWART SUTUT TRITASAVIT M.P.T.

MEDICARE: MR. STEWART SUTUT TRITASAVIT M.P.T.
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1336240514
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEWART SUTUT TRITASAVIT M.P.T.
Provider Business Mailing Address
First Line : 11301 WILSHIRE BLVD
Second Line : 117
City : LOS ANGELES
State : CA
Zip : 90073-1003
Country : US
Telephone Number : 310-478-3711
Fax Number :
Provider Business Practice Location Address
First Line : 11301 WILSHIRE BLVD
Second Line : BLDG.500 RM.1454
City : LOS ANGELES
State : CA
Zip : 90073-1003
Country : US
Telephone Number : 310-478-3711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/16/2007

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