Healthcare Provider Details

I. General information

NPI: 1740732080
Provider Name (Legal Business Name): KATIE E. SULLIVAN PT, DPT, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4094
US

IV. Provider business mailing address

3141 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4094
US

V. Phone/Fax

Practice location:
  • Phone: 192-274-5347
  • Fax:
Mailing address:
  • Phone: 192-274-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305210768
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPTL.0016395
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: