Provider Demographics
NPI:1518478189
Name:SULLIVAN, DANIEL DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVID
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15945
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4054
Mailing Address - Country:US
Mailing Address - Phone:410-729-4508
Mailing Address - Fax:
Practice Address - Street 1:70 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2622
Practice Address - Country:US
Practice Address - Phone:443-775-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
DEJ1-0014238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist