Provider Demographics
NPI:1023182326
Name:SULLIVAN, JOE LOWRY (CP)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:LOWRY
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 YORKDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5755
Mailing Address - Country:US
Mailing Address - Phone:804-745-5989
Mailing Address - Fax:
Practice Address - Street 1:2034 DABNEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3361
Practice Address - Country:US
Practice Address - Phone:804-649-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist