Individual
MATTHEW SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1935 WARNER AVE, SANTA FE, NM 87505-5452
(505) 906-6683
(505) 421-0271
Mailing address
1935 WARNER AVE, SANTA FE, NM 87505-5452
(505) 906-6683
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5279
NM
225100000X
Physical Therapist
PTL.0014097
CO
Other
Enumeration date
07/12/2016
Last updated
04/07/2022
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