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NPI Code Detail

MEDICARE: JOHN L SULLIVAN PTA

MEDICARE: JOHN L SULLIVAN PTA
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 AssistantP3 60394421WA

General Provider Information

NPI Number : 1235551953
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN L SULLIVAN PTA
Provider Business Mailing Address
First Line : 6720 E GREEN LAKE WAY N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-5439
Country : US
Telephone Number : 206-525-9666
Fax Number :
Provider Business Practice Location Address
First Line : 6720 E GREEN LAKE WAY N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-5439
Country : US
Telephone Number : 206-525-9666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2014
Last Update Date : 01/15/2014

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