Individual
JESSICA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
106 TONKIN ST, BEAVERTON, MI 48612-8116
(989) 435-3315
Mailing address
106 TONKIN ST, BEAVERTON, MI 48612-8116
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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