Provider Demographics
NPI:1316238975
Name:SUTHERLAND, TROY (ATC)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 STONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7578
Mailing Address - Country:US
Mailing Address - Phone:231-883-5280
Mailing Address - Fax:231-885-2613
Practice Address - Street 1:5123 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9201
Practice Address - Country:US
Practice Address - Phone:231-883-5280
Practice Address - Fax:231-885-2613
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner