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NPI Code Detail

MEDICARE: DENISE SULLIVAN PT

MEDICARE: DENISE 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 Therapist1247997TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112794143OTHERCAQH

General Provider Information

NPI Number : 1720489073
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE SULLIVAN PT
Provider Business Mailing Address
First Line : 3838 50TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79413-3808
Country : US
Telephone Number : 806-792-5522
Fax Number : 806-785-7582
Provider Business Practice Location Address
First Line : 3838 50TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79413-3808
Country : US
Telephone Number : 806-792-5522
Fax Number : 806-785-7582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2014
Last Update Date : 05/09/2022

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Directions to “ DENISE SULLIVAN PT” Practice Location

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