Individual
MICHAEL ASHBY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2152 JEFFERSON DAVIS HWY, STAFFORD, VA 22554-7273
(540) 751-8750
Mailing address
5 BALDWIN DR, FREDERICKSBURG, VA 22406-6264
(540) 751-8750
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019012217
VA
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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