Individual
MR. DAVID SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
100 N GRAPE ST APT 303, MEDFORD, OR 97501-3151
(718) 825-7245
Mailing address
2503 SARATOGA ST, ASHLAND, OR 97520-1892
(718) 825-7245
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22561
OR
Other
Enumeration date
04/30/2017
Last updated
10/29/2019
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