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General NPI Number Information
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NPI Number | 1073269320
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Entity Type | Individual
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Provider Name | GERROMI SULLIVAN BS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 1801 TURKEY POINT RD
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City | ESSEX
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State | MD
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Zip | 21221-1734
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Country | US
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Telephone | 240-602-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 6110 BREEZEWOOD DR APT 104
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City | GREENBELT
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State | MD
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Zip | 20770-4148
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Country | US
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Telephone | 240-602-6626
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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 | A0001160
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License Number State | MD
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