Individual
MS. JACQUELINE DENISE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA ATRIC
Contact information
Practice address
15884 MANCHESTER RD, ELLISVILLE, MO 63011
(636) 391-5400
(636) 394-9674
Mailing address
785 MANRESA, FLORISSANT, MO 63031-7237
(314) 921-5253
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2000161113
MO
Other
Enumeration date
09/26/2006
Last updated
07/08/2007
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