Provider Demographics
NPI:1093047722
Name:SULLIVAN, WHITNEY RACHEL (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:RACHEL
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N. 10TH
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-3003
Mailing Address - Country:US
Mailing Address - Phone:870-582-4201
Mailing Address - Fax:
Practice Address - Street 1:22 SOUTHPARK SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3307
Practice Address - Country:US
Practice Address - Phone:870-845-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT4392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer