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NPI Code Detail

MEDICARE: JILL GLENANN SUTTON DPT

MEDICARE: JILL GLENANN SUTTON DPT
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 Therapist6341SC

General Provider Information

NPI Number : 1902435076
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL GLENANN SUTTON DPT
Provider Business Mailing Address
First Line : 7580 CHARLOTTE HWY STE 1100
Second Line :
City : FORT MILL
State : SC
Zip : 29707-7803
Country : US
Telephone Number : 803-548-5662
Fax Number : 803-548-5635
Provider Business Practice Location Address
First Line : 7580 CHARLOTTE HWY STE 1100
Second Line :
City : FORT MILL
State : SC
Zip : 29707-7803
Country : US
Telephone Number : 803-548-5662
Fax Number : 803-548-5635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2020
Last Update Date : 04/02/2020

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