Provider Demographics
NPI:1225275936
Name:SULLIVAN, WILLIAM JOSEPH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:115 ATRIUM WAY
Mailing Address - Street 2:STE 232
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6371
Mailing Address - Country:US
Mailing Address - Phone:803-788-8484
Mailing Address - Fax:803-788-8499
Practice Address - Street 1:115 ATRIUM WAY
Practice Address - Street 2:STE 232
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6371
Practice Address - Country:US
Practice Address - Phone:803-788-8484
Practice Address - Fax:803-788-8499
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist