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Individual

NANCY SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
1040 NW 22ND AVE, SUITE 520, PORTLAND, OR 97210-3057
(503) 413-7556
(503) 413-6547
Mailing address
1040 NW 22ND AVE, SUITE 520, PORTLAND, OR 97210-3097
(503) 413-7556
(503) 413-6547

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
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