MEDICARE: CATHERINE SULLIVAN PT

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	10077	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922050574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE SULLIVAN PT

Provider Business Mailing Address
First Line	:	1 CREDIT UNION WAY FL 3
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-4633
Country	:	US
Telephone Number	:	781-961-3370
Fax Number	:	781-961-1291

Provider Business Practice Location Address
First Line	:	16 ALDRIN RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4804
Country	:	US
Telephone Number	:	508-830-0093
Fax Number	:	508-830-1425

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/10/2018

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Directions to “ CATHERINE SULLIVAN PT” Practice Location

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