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NPI Code Detail

MEDICARE: SHAUN M SULLIVAN PT

MEDICARE: SHAUN M 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
1225100000XPhysical Therapist5501003708MI

General Provider Information

NPI Number : 1144221342
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUN M SULLIVAN PT
Provider Business Mailing Address
First Line : 2618 CENTER AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6300
Country : US
Telephone Number : 989-892-4557
Fax Number : 989-892-4686
Provider Business Practice Location Address
First Line : 2618 CENTER AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6300
Country : US
Telephone Number : 989-892-4557
Fax Number : 989-892-4686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 04/21/2011

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Directions to “ SHAUN M SULLIVAN PT” Practice Location

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