MEDICARE: LORI MCCOY SULLIVAN PT

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	174400000X	Specialist	2269	NC
2	225100000X	Physical Therapist	P2269	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2269	OTHER	NC	PT LICENSE

General Provider Information

NPI Number	:	1013128412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MCCOY SULLIVAN PT

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	252-726-1802
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 N 35TH ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3182
Country	:	US
Telephone Number	:	252-726-1802
Fax Number	:	252-726-1805

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/08/2025

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