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General NPI Number Information
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NPI Number | 1881834117
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Entity Type | Individual
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Provider Name | MICHAEL JAMES SULLIVAN PT
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Gender | Male
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 1966 STATE ROAD
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City | PLYMOUTH
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State | MA
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Zip | 02360
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Country | US
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Telephone | 508-888-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 WEST CHESTNUT STREET
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-559-0473
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Fax | 508-427-5361
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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 | 3469
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License Number State | MA
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