Individual
JOANNE DAMIN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
90 GROVE ST, SUITE 106, RIDGEFIELD, CT 06877-4114
(203) 431-8471
(203) 438-9543
Mailing address
31 OLD ROUTE 7, BROOKFIELD, CT 06804-1714
(203) 740-0020
(203) 775-0238
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002634
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004210217
—
CT
01
—
080002634CT01
ANTHEM BC
CT
Enumeration date
06/16/2006
Last updated
03/11/2009
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