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NPI Code Detail

MEDICARE: MRS. CHRISTIE SULLIVAN HEATH P.T.

MEDICARE: MRS. CHRISTIE SULLIVAN HEATH P.T.
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
1174400000XSpecialist3583LA

General Provider Information

NPI Number : 1558317511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTIE SULLIVAN HEATH P.T.
Provider Business Mailing Address
First Line : 1219 CHURCH ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-2347
Country : US
Telephone Number : 225-658-7751
Fax Number : 225-658-7753
Provider Business Practice Location Address
First Line : 1219 CHURCH ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-2347
Country : US
Telephone Number : 225-658-7751
Fax Number : 225-658-7753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/08/2007

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