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General NPI Number Information
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NPI Number | 1003345554
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Entity Type | Individual
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Provider Name | BRIDGET SULLIVAN ATC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 4030 WELLMAN WAY MILLER CENTER
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City | WINSTON-SALEM
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State | NC
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Zip | 27109
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Country | US
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Telephone | 336-758-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 126 BROOKSTOWN AVE APT 150
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City | WINSTON SALEM
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State | NC
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Zip | 27101-5377
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Country | US
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Telephone | 615-491-3014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-4697
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License Number State | NC
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