Provider Demographics
NPI:1104683051
Name:SUTTON, GILLIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34645 2800 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA MOILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61330-9358
Mailing Address - Country:US
Mailing Address - Phone:815-501-1393
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6729225100000X
CA305707225100000X
COPTL.0019495225100000X
IL070.027819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist