Provider Demographics
NPI:1427644392
Name:SUTTON, CASEY MICHELLE
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:MICHELLE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 BEN CRENSHAW WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6163
Mailing Address - Country:US
Mailing Address - Phone:512-917-7951
Mailing Address - Fax:
Practice Address - Street 1:116 N LITTLE HORN AVE
Practice Address - Street 2:
Practice Address - City:MOORCROFT
Practice Address - State:WY
Practice Address - Zip Code:82721-5045
Practice Address - Country:US
Practice Address - Phone:307-756-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1340380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist