Provider Demographics
NPI:1073995437
Name:SULLIVAN, SABRINA (LPTA)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 CABARET TRL S
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2284
Mailing Address - Country:US
Mailing Address - Phone:989-790-3781
Mailing Address - Fax:989-790-3782
Practice Address - Street 1:3099 CABARET TRL S
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2284
Practice Address - Country:US
Practice Address - Phone:989-790-3781
Practice Address - Fax:989-790-3782
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant