Provider Demographics
NPI:1194161661
Name:SUTTLE, LATASHA ROSHAWN (LPTA)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:ROSHAWN
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 W ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0871
Mailing Address - Country:US
Mailing Address - Phone:918-872-1825
Mailing Address - Fax:
Practice Address - Street 1:1112 W ELMIRA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-0871
Practice Address - Country:US
Practice Address - Phone:918-872-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1664225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant