Individual
MRS. MARIA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
540 LAKE CENTER PKWY, SUITE 107, CUMMING, GA 30040-7727
(770) 205-3939
Mailing address
1520 PURPLE MARTIN TRCE, CUMMING, GA 30041-9343
(770) 886-1332
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA001177
LICENSE#
GA
Enumeration date
08/30/2006
Last updated
11/09/2009
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