MEDICARE: MICHELLE SULLIVAN MSPT

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	PT2584	ME
2	225100000X	Physical Therapist	P19629	NC
3	225100000X	Physical Therapist	218905	ME

General Provider Information

NPI Number	:	1376727909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SULLIVAN MSPT

Provider Business Mailing Address
First Line	:	292 COMMERCE AVE
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-7059
Country	:	US
Telephone Number	:	910-757-0408
Fax Number	:	910-757-0413

Provider Business Practice Location Address
First Line	:	292 COMMERCE AVE
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-7059
Country	:	US
Telephone Number	:	910-757-0408
Fax Number	:	910-757-0413

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	02/04/2026

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