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General NPI Number Information
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NPI Number | 1376653964
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Entity Type | Individual
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Provider Name | MARIA SULLIVAN PTA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 540 LAKE CENTER PKWY SUITE 107
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City | CUMMING
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State | GA
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Zip | 30040-7727
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Country | US
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Telephone | 770-205-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 PURPLE MARTIN TRCE
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City | CUMMING
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State | GA
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Zip | 30041-9343
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Country | US
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Telephone | 770-886-1332
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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