Individual
JENELLE M SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1116 MAPLE WAY, JACKSON, WY 83002
(307) 733-7037
Mailing address
1116 MAPLE WAY, P.O. BOX 9725, JACKSON, WY 83002
(307) 733-7037
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1097
WY
Other
Enumeration date
12/05/2006
Last updated
10/07/2010
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