Provider Demographics
NPI:1467601229
Name:SULT, MARY E (LAT, ATC, ROT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SULT
Suffix:
Gender:F
Credentials:LAT, ATC, ROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 LAKECREST AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2683
Mailing Address - Country:US
Mailing Address - Phone:336-906-0324
Mailing Address - Fax:
Practice Address - Street 1:860 LAKECREST AVE APT 2B
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2683
Practice Address - Country:US
Practice Address - Phone:336-906-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16282255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
091817050OtherAMERICAN SOCIETY OF ORTHOPEDIC PROFESSIONALS
030802029OtherBOARD OF CERTIFICATION, INC
NC1628OtherNORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS