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General NPI Number Information
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NPI Number | 1083520829
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Entity Type | Individual
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Provider Name | SAMANTHA JO SULLIVAN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 3146 E 11TH STREET
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City | TULSA
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State | OK
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Zip | 74104
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Country | US
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Telephone | 918-727-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 6115 S NEW HAVEN AVE
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City | TULSA
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State | OK
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Zip | 74136-1510
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3417
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7110
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License Number State | OK
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