Most Relevant Information
Provider Data
| NPI Number: | 1003655499 |
| Provider Name: | ETHAN ALEXANDER SUTTON PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 0015448 |
Most Important Dates
| Enumeration Date: | 05/23/2024 |
| Last Updated: | 05/23/2024 |
Provider Practice Location
589 TRIMBLE LN
DURANGO
CO
813017101
Practice Location Phone/Fax
| Phone: | 9702592547 |
| Fax: |
Provider Mailing Location
589 TRIMBLE LN
DURANGO
CO
813017101
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |