Provider Demographics
NPI:1225451347
Name:SULLIVAN, SARA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 NURSERY RD APT 41-203
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7656
Mailing Address - Country:US
Mailing Address - Phone:727-484-4620
Mailing Address - Fax:
Practice Address - Street 1:4450 E FLETCHER AVE STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4907
Practice Address - Country:US
Practice Address - Phone:813-540-4777
Practice Address - Fax:813-336-2112
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL29622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer