Provider Demographics
NPI:1497311062
Name:SULLIVAN, STEVEN GLEN (CRT, RPSGT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GLEN
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:CRT, RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 HOPE RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29432
Mailing Address - Country:US
Mailing Address - Phone:803-331-5772
Mailing Address - Fax:
Practice Address - Street 1:803 HOPE RD
Practice Address - Street 2:
Practice Address - City:BRANCHVILLE
Practice Address - State:SC
Practice Address - Zip Code:29432
Practice Address - Country:US
Practice Address - Phone:803-331-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3273227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified