Individual
PAUL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
75-5699 KOPIKO ST, KAILUA KONA, HI 96740-1668
(808) 329-7744
Mailing address
75-5699 KOPIKO ST, KAILUA KONA, HI 96740-1668
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 2206
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000244996
HMSA/BC-BS
HI
01
—
244996
HMSA 65C
HI
05
—
576639-01
—
HI
01
—
8457294
UHA
HI
01
—
A013
TRICARE
HI
Enumeration date
11/06/2006
Last updated
02/14/2008
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