Individual
GRANT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13 CEDARCONE CT, NOTTINGHAM, MD 21236-1675
(301) 706-0612
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(866) 370-8206
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
25301
MD
Other
Enumeration date
01/18/2016
Last updated
01/26/2026
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