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Individual

MARY SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
12301 LAKE UNDERHILL RD STE 118, ORLANDO, FL 32828-4510
(407) 218-4660
(407) 218-4661
Mailing address
12301 LAKE UNDERHILL RD STE 118, ORLANDO, FL 32828-4510
(407) 218-4660
(407) 218-4661

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA940
FL

Other

Enumeration date
09/30/2010
Last updated
09/30/2010
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