Individual
MARLYSA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3901 LOCH RAVEN BLVD, BALTIMORE, MD 21218-2109
(404) 791-5230
Mailing address
3901 LOCH RAVEN BLVD, BALTIMORE, MD 21218-2109
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT007465
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT007465
STATE LISC NUMBER
GA
Enumeration date
11/08/2006
Last updated
02/10/2026
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