Individual
MELANIE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6866 JACK LONDON DR, JOHNSTON, IA 50131-4755
(641) 832-8690
Mailing address
6866 JACK LONDON DR, JOHNSTON, IA 50131-4755
(641) 832-8690
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
074902
IA
Other
Enumeration date
05/25/2016
Last updated
05/25/2016
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