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Individual
SUSAN CLAIRE SULLIVAN
Active
Individual
SUSAN CLAIRE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006299
OH
225100000X
Physical Therapist
4018
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006299
OHIO LICENSE
OH
01
—
4018
KENTUCKY LICENSE
KY
Enumeration date
07/17/2008
Last updated
11/21/2011
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