Tisha Dawn Sutton, MPT
Individual provider Active NPI Orthopedic Physical Therapist
NPI 1780646703 · NPPES record last updated Jan 17, 2014
Key facts
- NPI
- 1780646703
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 3549 (OK)
- Practice address
- 52ND MDG/Spangdahlem Clinic
Building 550
Apo, AE 09123 - Phone
- (314) 452-8430
- NPI assigned
- Apr 5, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Greendale Physical Therapy LLC
Boston Health and Wellness LLC
Practice addresses (Care Compare)
435 Lakeside Ave
Marlborough, MA 01752-1979
Phone (855) 459-5000
62 Montvale Ave
Suite Z
Stoneham, MA 02180-3600
Phone (617) 843-5320
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250620000773 | MA | Practitioner - Physical Therapist in Private Practice | 7315129061 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greendale Physical Therapy, LLC | Orthopedic | Current |
Accepting new patients |
Locations
435 Lakeside Ave
Marlborough, MA 01752
Phone (508) 488-4110
280 Boston Tpke
Shrewsbury, MA 01545
Phone (508) 753-7780
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 3549 | OK | Yes |
Addresses
Primary practice location
52ND MDG/Spangdahlem Clinic
Building 550
Apo, AE 09123
Mailing address
PSC 9 Box 5936
Apo, AE 09123-0060
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.