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Organization
SULLIVAN REHAB INC
Active
Organization
SULLIVAN REHAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MARSH (DIRECTOR)
(813) 655-3342
Entity
Organization
Contact information
Practice address
116 E BLOOMINGDALE AVE, BRANDON, FL 33511-8101
(813) 655-3342
(813) 653-0894
Mailing address
116 E BLOOMINGDALE AVE, BRANDON, FL 33511-8101
(813) 655-3342
(813) 653-0894
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6405105
UNITED HEALTH CARE
FL
01
—
Y908V
BLUE CROSS BLUE SHIELD PR
FL
Enumeration date
09/12/2006
Last updated
08/31/2007
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