Provider Demographics
NPI:1487847315
Name:SULLENBERGER, JAMES MADISON (LPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MADISON
Last Name:SULLENBERGER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PINEHURST DRIVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2442
Mailing Address - Country:US
Mailing Address - Phone:828-692-2717
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL DRIVE
Practice Address - Street 2:ST LUKES HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-6418
Practice Address - Country:US
Practice Address - Phone:828-894-3311
Practice Address - Fax:828-894-0538
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist