Individual
DR. SUTHERLAND WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
754 N COLLEGE RD STE D, TWIN FALLS, ID 83301-5822
(208) 734-5313
Mailing address
504 JEROME ST E, TWIN FALLS, ID 83301-6269
(530) 514-9248
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7263
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427029610
—
ID
Enumeration date
05/17/2021
Last updated
05/17/2021
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