Individual
MR. MARK EDWARD SULLENBARGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1029 E 5TH ST, CONNERSVILLE, IN 47331-3301
(765) 825-0543
Mailing address
1029 E 5TH ST, CONNERSVILLE, IN 47331-3301
(765) 825-0543
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003711A
IN
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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