MEDICARE: KAREN M. 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
1	225100000X	Physical Therapist	PT00956	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6025	OTHER	MA	STATE LICENSE
2	PT00956	OTHER	RI	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1174638415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M. SULLIVAN P.T.

Provider Business Mailing Address
First Line	:	PO BOX 20372
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-0944
Country	:	US
Telephone Number	:	401-785-1016
Fax Number	:	401-785-1018

Provider Business Practice Location Address
First Line	:	1140 MENDON ROAD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-4805
Country	:	US
Telephone Number	:	401-333-9787
Fax Number	:	401-333-9785

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/11/2025

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