Sally Sutkowski, R, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070000502 Issued in IL

Practice address

5401 N Knoxville Ave
Suite 117
Peoria, IL 61614-5098

Phone

(309) 671-8749

NPI assigned

Apr 11, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1497045405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 N GRANDVIEW DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616165418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 117",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-671-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTKOWSKI",
        "first_name": "SALLY",
        "credential": "R, P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070000502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "070000502",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "216706",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Supportive Steps Home Healthcare
• Omprakash N. Sureka, MD
• Rachana Sureka, MD
• Erin Surratt, LCSW
• Susan J Cole, MD & Associates
• Jonathan R Sutter, PT, DPT
• Randall Scott Sutter, M.D.
• Abigail Rose Sutton, PA-C
• Pamela Taylor Sutton, LCPC
• Dynae Marie Svendsen, PTA

• Physical Therapist in Peoria, IL
• Providers in Peoria, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.