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NPI Code Detail

MEDICARE: ANNA SULLIVAN

MEDICARE: ANNA SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant073829IA

General Provider Information

NPI Number : 1043629603
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA SULLIVAN
Provider Business Mailing Address
First Line : 1204 LINDEN ST
Second Line :
City : DALLAS CENTER
State : IA
Zip : 50063-1052
Country : US
Telephone Number : 515-992-3735
Fax Number :
Provider Business Practice Location Address
First Line : 1204 LINDEN ST
Second Line :
City : DALLAS CENTER
State : IA
Zip : 50063-1052
Country : US
Telephone Number : 515-992-3735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2014
Last Update Date : 08/07/2014

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Directions to “ ANNA SULLIVAN ” Practice Location

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