Individual
MRS. LINDA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
369 GRAND VALLEY BLVD, MARTINSVILLE, IN 46151-5851
(765) 349-9255
(765) 349-6030
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002873A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200651380
RENDERING PROVIDER NUMBER
IN
01
—
200717330A
PROVIDER NUMBER
IN
Enumeration date
12/21/2006
Last updated
04/22/2016
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