Individual
KATIE E. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, NCS
Contact information
Practice address
3141 CENTENNIAL BLVD, COLORADO SPRINGS, CO 80907-4094
(192) 274-5347
Mailing address
3141 CENTENNIAL BLVD, COLORADO SPRINGS, CO 80907-4094
(192) 274-5347
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305210768
VA
2251N0400X
Neurology Physical Therapist
Primary
PTL.0016395
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05954
MEDICARE GROUP PTAN
VA
Enumeration date
11/03/2016
Last updated
05/24/2021
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