Healthcare Provider Details

I. General information

NPI: 1871554352
Provider Name (Legal Business Name): KRISTINA ANN SULLIVAN MPT, ATC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA A TEMPORITI MPT,ATC, LMT

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 VOGEL RD
ARNOLD MO
63010-3790
US

IV. Provider business mailing address

8120 PARKRIDGE DR
SAINT LOUIS MO
63123-4825
US

V. Phone/Fax

Practice location:
  • Phone: 636-461-0900
  • Fax: 636-461-0047
Mailing address:
  • Phone: 314-608-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2009004976
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2010036452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: