Healthcare Provider Details

I. General information

NPI: 1649104720
Provider Name (Legal Business Name): HANNAH M SULLIVAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E EVERGREEN DR
APPLETON WI
54913-8910
US

IV. Provider business mailing address

2575 E EVERGREEN DR
APPLETON WI
54913-8910
US

V. Phone/Fax

Practice location:
  • Phone: 920-277-4364
  • Fax:
Mailing address:
  • Phone: 920-277-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17790-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: