Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1023182326 |
---|---|
Provider Name | Joe Lowry Sullivan |
First Address | Richmond, VA 23235-5755 |
Second Address | Richmond, VA 23230-3361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |