Healthcare Provider Details

I. General information

NPI: 1669348876
Provider Name (Legal Business Name): VICTORIA LEE SULLIVAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4830 KNIGHTSBRIDGE BLVD
COLUMBUS OH
43214-2300
US

IV. Provider business mailing address

4830 KNIGHTSBRIDGE BLVD
COLUMBUS OH
43214-2300
US

V. Phone/Fax

Practice location:
  • Phone: 614-559-8677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT021810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: