Individual
JACK SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
18561 N 59TH AVE, GLENDALE, AZ 85308-1256
(602) 313-4089
(623) 322-0664
Mailing address
2001 BUTTERFIELD RD STE 1600, DOWNERS GROVE, IL 60515-1211
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LPT-32921
AZ
225100000X
Physical Therapist
—
—
Other
Enumeration date
11/19/2020
Last updated
02/06/2025
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