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NPI Code Detail

MEDICARE: MARIANNE SULLIVAN P.T.

MEDICARE: MARIANNE SULLIVAN P.T.
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
1225100000XPhysical TherapistPT 18597CA

General Provider Information

NPI Number : 1134170442
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNE SULLIVAN P.T.
Provider Business Mailing Address
First Line : 28371 CAMINO DIMORA
Second Line :
City : SAN JUAN CAPISTRANO
State : CA
Zip : 92675-6300
Country : US
Telephone Number : 310-962-4203
Fax Number :
Provider Business Practice Location Address
First Line : 31271 NIGUEL RD STE J
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-4135
Country : US
Telephone Number : 949-443-5442
Fax Number : 949-443-5436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 11/14/2023

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Directions to “ MARIANNE SULLIVAN P.T.” Practice Location

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