MEDICARE: MS. THERESA K 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
1	225100000X	Physical Therapist	PT00008395	WA

General Provider Information

NPI Number	:	1194734491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA K SULLIVAN

Provider Business Mailing Address
First Line	:	7900 E GREEN LAKE DR N
Second Line	:	SUITE 204
City	:	SEATTLE
State	:	WA
Zip	:	98103-4800
Country	:	US
Telephone Number	:	206-985-2236
Fax Number	:	206-985-2248

Provider Business Practice Location Address
First Line	:	7900 E GREEN LAKE DR N
Second Line	:	SUITE 204
City	:	SEATTLE
State	:	WA
Zip	:	98103-4800
Country	:	US
Telephone Number	:	206-985-2236
Fax Number	:	206-985-2248

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/07/2009

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