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NPI Code Detail

MEDICARE: NEKITA J SULLIVAN PT

MEDICARE: NEKITA J 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 Therapist4014SC

General Provider Information

NPI Number : 1598701856
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEKITA J SULLIVAN PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 333 S PINE ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29302-2622
Country : US
Telephone Number : 864-515-7580
Fax Number : 864-515-7581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 12/20/2016

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Directions to “ NEKITA J SULLIVAN PT” Practice Location

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