MEDICARE: MR. TODD MICHAEL SULLIVAN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05008436A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4423623	OTHER	IN	AETNA
2	N282359	OTHER	IN	HARMONY
3	1424	OTHER	IN	PHP
4	000000340405	OTHER	IN	ANTHEM BCBS
5	35179001202	OTHER	IN	CARESOURCE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003982711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD MICHAEL SULLIVAN MPT

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3978 NEW VISION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1712
Country	:	US
Telephone Number	:	260-373-9318
Fax Number	:	260-373-9301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	02/17/2025

Similar Medicare Providers

1073508461 — DR. GERRY S EASTERDAY MD
Practice Location Address:

3978 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-672-4680
Practice Fax: 260-672-4685

1124063102 — DR. JUDY L. ZACHER M.D.
Practice Location Address:

3974 NEW VISION DRIVE
FORT WAYNE, IN
46845-1712

Practice Phone: 260-471-5980
Practice Fax: 260-471-5981

1861437642 — WOMEN CARING FOR WOMEN
Practice Location Address:

3974 NEW VISION DRIVE
FORT WAYNE, IN
46845-1712

Practice Phone: 260-471-5980
Practice Fax: 260-471-5981

1396781233 — CARYN THEOBALD MD
Practice Location Address:

3926 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 419-445-2015
Practice Fax: 419-445-8102

1437168317 — MS. JACQUELINE MOORHEAD CHEN PT
Practice Location Address:

3982 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-483-9933
Practice Fax: 260-483-9931

1982799912 — MRS. VALERIE LYNN GUALDONI MA,CCC-SLP
Practice Location Address:

3926 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-373-2300
Practice Fax: 260-373-2335

Directions to “ MR. TODD MICHAEL SULLIVAN MPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.