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NPI Code Detail

MEDICARE: LORI SULLIVAN

MEDICARE: LORI SULLIVAN
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
1225200000XPhysical Therapy Assistant2366NY

General Provider Information

NPI Number : 1114066651
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI SULLIVAN
Provider Business Mailing Address
First Line : 3940 CALIFORNIA RD
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-2275
Country : US
Telephone Number : 716-662-2922
Fax Number : 716-662-3828
Provider Business Practice Location Address
First Line : 3940 CALIFORNIA RD
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-2275
Country : US
Telephone Number : 716-662-2922
Fax Number : 716-662-3828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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Directions to “ LORI SULLIVAN ” Practice Location

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