Individual
NANCY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60187
OR
225100000X
Physical Therapist
PT12501
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60187
OREGON PHYSICAL THERAPY LICENSE
OR
Enumeration date
10/25/2006
Last updated
01/03/2014
Update your record
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