MEDICARE: WILLIAM A SULLIVAN DPT

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
1	225100000X	Physical Therapist	CP026249T	NC
2	225100000X	Physical Therapist	2305215020	VA

General Provider Information

NPI Number	:	1053059642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A SULLIVAN DPT

Provider Business Mailing Address
First Line	:	PO BOX 412307
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2307
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	150 BURNETTS WAY STE 230
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8168
Country	:	US
Telephone Number	:	757-942-2022
Fax Number	:	757-512-8997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	03/18/2026

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