MEDICARE: DR. KIMBERLEE DAWN SULLIVAN DPT

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	1151958	TX

General Provider Information

NPI Number	:	1639108103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLEE DAWN SULLIVAN DPT

Provider Business Mailing Address
First Line	:	12411 HYMEADOW DR
Second Line	:	BUILDING 3 SUITE 3B
City	:	AUSTIN
State	:	TX
Zip	:	78750-1874
Country	:	US
Telephone Number	:	512-335-9300
Fax Number	:	512-335-9301

Provider Business Practice Location Address
First Line	:	12411 HYMEADOW DR
Second Line	:	BUILDING 3 SUITE 3B
City	:	AUSTIN
State	:	TX
Zip	:	78750-1874
Country	:	US
Telephone Number	:	512-335-9300
Fax Number	:	512-335-9301

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/26/2015

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