Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0676 | NH |
NPI | 1063598951 |
---|---|
Provider Name | Tammie Sullivan |
First Address | Dunbarton, NH 03046-4424 |
Second Address | Concord, NH 03301-2548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |