Individual
HALINA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
70 AVONDALE RD, LONGMEADOW, MA 01106-2704
(413) 567-0987
Mailing address
70 AVONDALE RD, LONGMEADOW, MA 01106-2704
(413) 567-0987
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15155
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15155
PROFESSIONAL LICENSURE/PT
MA
Enumeration date
09/08/2007
Last updated
09/08/2007
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