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NPI Code Detail

MEDICARE: MRS. ANGELA RENEA SULLIVAN LPTA

MEDICARE: MRS. ANGELA RENEA SULLIVAN LPTA
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 AssistantTE007473PA

General Provider Information

NPI Number : 1396917076
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA RENEA SULLIVAN LPTA
Provider Business Mailing Address
First Line : 80 ASPEN WAY
Second Line :
City : SCHWENKSVILLE
State : PA
Zip : 19473-2330
Country : US
Telephone Number : 610-287-7710
Fax Number :
Provider Business Practice Location Address
First Line : 305 CHERRY ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-1803
Country : US
Telephone Number : 215-238-9848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2008
Last Update Date : 04/02/2008

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