Provider Demographics
NPI:1093123465
Name:SULLIVAN, JAMES DENNIS (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DENNIS
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 MONROEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2608
Mailing Address - Country:US
Mailing Address - Phone:412-856-7570
Mailing Address - Fax:412-373-5061
Practice Address - Street 1:4142 MONROEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2608
Practice Address - Country:US
Practice Address - Phone:412-856-7570
Practice Address - Fax:412-373-5061
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO19698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist