MEDICARE: GRANT 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	25301	MD

General Provider Information

NPI Number	:	1851758106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT SULLIVAN

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 CEDARCONE CT
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-1675
Country	:	US
Telephone Number	:	301-706-0612
Fax Number	:

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

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	01/26/2026

Similar Medicare Providers

1912856725 — ULTIMATE PERFORMANCE LAB LLC
Practice Location Address:

13 CEDARCONE CT
NOTTINGHAM, MD
21236-1675

Practice Phone: 301-706-0612
Practice Fax:

1295688232 — MAS COUNSELING & CONSULTATION LLC
Practice Location Address:

7809 LONGRIDGE RD
NOTTINGHAM, MD
21236-3831

Practice Phone: 410-497-7226
Practice Fax:

1528669728 — AZURA ANESTHESIA PARTNERS LLC
Practice Location Address:

8140 CORPORATE DR STE 125
NOTTINGHAM, MD
21236-6901

Practice Phone: 410-931-9729
Practice Fax: 410-931-2133

1992664999 — KATHERINE YEAGLE
Practice Location Address:

7629 BELAIR RD
NOTTINGHAM, MD
21236-4003

Practice Phone: 410-870-2104
Practice Fax: 410-870-6896

1790636207 — BRIAN RIGHINI
Practice Location Address:

7939 HONEYGO BLVD STE 127
NOTTINGHAM, MD
21236-5905

Practice Phone: 866-727-8274
Practice Fax:

1538927868 — PRECIOUS OTU ITA
Practice Location Address:

7698 BELAIR RD STE C1
NOTTINGHAM, MD
21236-4066

Practice Phone: 410-558-7798
Practice Fax:

Directions to “ GRANT SULLIVAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.