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Individual
SALLY SUTKOWSKI
Active
Individual
SALLY SUTKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R, P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070000502
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070000502
LICENSE
IL
01
—
216706
GROUP PTAN
IL
Enumeration date
04/11/2011
Last updated
10/17/2011
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