Healthcare Provider Details

I. General information

NPI: 1013831163
Provider Name (Legal Business Name): ANDREW SULLIVAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 7TH ST
RAPID CITY SD
57701-4661
US

IV. Provider business mailing address

2125 WESTGATE PL
RAPID CITY SD
57702-5191
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-6474
  • Fax: 605-716-6484
Mailing address:
  • Phone: 605-716-6474
  • Fax: 605-716-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6314
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: