Individual
KATIE LEIGH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 433-4700
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10366-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10366-24
PT
WI
Enumeration date
07/21/2006
Last updated
02/07/2023
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