Individual
VICKY LYNN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
90 SUNSET DRIVE, LA GRANDE, OR 97850
(541) 963-1437
(541) 963-1890
Mailing address
PO BOX 3290, 900 SUNSET DRIVE, LA GRANDE, OR 97850
(541) 963-1437
(541) 963-1890
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8027
OR
Other
Enumeration date
07/24/2006
Last updated
02/09/2012
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