MEDICARE: RYAN JAMES 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

General Provider Information

NPI Number	:	1902731417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JAMES SULLIVAN

Provider Business Mailing Address
First Line	:	9653 CAPELLA AVE NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-3599
Country	:	US
Telephone Number	:	704-785-4069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 N HOWE ST
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-2772
Country	:	US
Telephone Number	:	910-332-3828
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ RYAN JAMES SULLIVAN ” Practice Location

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