Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT000606E | PA |
NPI | 1003048935 |
---|---|
Provider Name | Annpat Sullivan |
First Address | Tresckow, PA 18254-0051 |
Second Address | Wilkes Barre, PA 18705-3738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 11/08/2009 |