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NPI Code Detail

MEDICARE: SCOTT A. SUTPHIN PTA

MEDICARE: SCOTT A. SUTPHIN PTA
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
1225200000XPhysical Therapy Assistant2306602211VA

General Provider Information

NPI Number : 1942354766
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT A. SUTPHIN PTA
Provider Business Mailing Address
First Line : 4550 SHENANDOAH AVE NW
Second Line :
City : ROANOKE
State : VA
Zip : 24017-4749
Country : US
Telephone Number : 540-982-2860
Fax Number :
Provider Business Practice Location Address
First Line : 4550 SHENANDOAH AVE NW
Second Line :
City : ROANOKE
State : VA
Zip : 24017-4749
Country : US
Telephone Number : 540-982-2860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 12/03/2015

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Directions to “ SCOTT A. SUTPHIN PTA” Practice Location

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