Healthcare Provider Details

I. General information

NPI: 1326165200
Provider Name (Legal Business Name): HEATHER STONE SULLIVAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N MEADOWS RD
MEDFIELD MA
02052-2317
US

IV. Provider business mailing address

32 TIMBERLINE RD
MILLIS MA
02054-1149
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-9119
  • Fax: 508-359-9115
Mailing address:
  • Phone: 781-367-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number17688
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: