Individual
MR. JAMES FRED SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RKT CEP
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 424-6106
(318) 429-5727
Mailing address
110 HUNTER LEE LN, STONEWALL, LA 71078-4800
(318) 925-3778
Taxonomy
Speciality
Code
Description
License number
State
226300000X
Kinesiotherapist
Primary
621
LA
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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