Provider Demographics
NPI:1235599556
Name:O'SULLIVAN, DAMIEN
Entity Type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:1823 NW MAYNARD RD
Practice Address - Street 2:ATHLETIC PERFORMANCE CENTER
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3182
Practice Address - Country:US
Practice Address - Phone:919-535-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist