Provider Demographics
NPI:1811979891
Name:SUTTON, SOMER ANNE JOYCE (DPT)
Entity type:Individual
Prefix:
First Name:SOMER
Middle Name:ANNE JOYCE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SOMER
Other - Middle Name:ANNE
Other - Last Name:HEPNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:810 E 23RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2135
Mailing Address - Country:US
Mailing Address - Phone:605-322-5083
Mailing Address - Fax:
Practice Address - Street 1:810 E 23RD ST FL 2
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2135
Practice Address - Country:US
Practice Address - Phone:605-322-5150
Practice Address - Fax:605-322-5174
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2301225100000X
NE2048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36584OtherBLUE CROSS BLUE SHIELD
IA0586412Medicaid
IA0586412Medicaid
NE36584OtherBLUE CROSS BLUE SHIELD
NEP00199706Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER