Individual
JULIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1049 N EDGE TRL, VERONA, WI 53593-1942
(608) 845-2100
(608) 845-2101
Mailing address
1049 N EDGE TRL, VERONA, WI 53593-1942
(608) 845-2100
(608) 845-2101
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11876-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000083455
MEDICARE
WI
Enumeration date
11/22/2011
Last updated
11/22/2011
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