Individual
WYATT SUTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13537 BARRETT PARKWAY DR STE 105, BALLWIN, MO 63021-5896
(618) 623-1197
Mailing address
308 E AIRWOOD DR, EAST ALTON, IL 62024-1853
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096005457
IL
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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