MEDICARE: MICHAEL SAUTTER MPT

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	225100000X	Physical Therapist	PT19100	CA

General Provider Information

NPI Number	:	1659316404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SAUTTER MPT

Provider Business Mailing Address
First Line	:	6029 BRISTOL PKWY
Second Line	:	100
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6643
Country	:	US
Telephone Number	:	310-417-5901
Fax Number	:	310-410-1001

Provider Business Practice Location Address
First Line	:	4560 ADMIRALTY WAY
Second Line	:	100
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5423
Country	:	US
Telephone Number	:	310-656-1770
Fax Number	:	310-578-5379

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	03/07/2008

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