Individual
MS. MICHELE KATHLEEN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
3303 SW BOND AVE, PORTLAND, OR 97239-4501
(503) 494-3151
Mailing address
4541 SW FAIRHAVEN DR, PORTLAND, OR 97221-2609
(503) 525-8457
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4199
OR
Other
Enumeration date
09/07/2006
Last updated
04/03/2020
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