Healthcare Provider Details

I. General information

NPI: 1679459671
Provider Name (Legal Business Name): ALEXANDER SULLIVAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON AVE BLDG B
NORWALK CT
06854-4631
US

IV. Provider business mailing address

1690 2ND AVE FRNT 3
NEW YORK NY
10128-5950
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-6802
  • Fax:
Mailing address:
  • Phone: 212-203-6802
  • Fax: 212-377-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14995
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: