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NPI Code Detail

MEDICARE: MR. IVAN SULTAN MPT

MEDICARE: MR. IVAN SULTAN MPT
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
1225100000XPhysical Therapist6705OR

General Provider Information

NPI Number : 1871506659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IVAN SULTAN MPT
Provider Business Mailing Address
First Line : 748 15TH ST
Second Line :
City : ASTORIA
State : OR
Zip : 97103-3824
Country : US
Telephone Number : 503-468-2469
Fax Number : 503-338-7557
Provider Business Practice Location Address
First Line : 2265 EXCHANGE ST
Second Line :
City : ASTORIA
State : OR
Zip : 97103-3331
Country : US
Telephone Number : 503-338-4005
Fax Number : 503-338-7557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 07/15/2013

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