Provider Demographics
NPI:1114015955
Name:SULLIVAN, CARI ROSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARI
Middle Name:ROSE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:A
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2931 E. BIDDLE ST
Mailing Address - Street 2:PATIENT ACCOUNTING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213
Mailing Address - Country:US
Mailing Address - Phone:443-923-1872
Mailing Address - Fax:
Practice Address - Street 1:707 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:443-923-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21542225100000X
21542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist