Provider Demographics
NPI:1598857567
Name:SULLIVAN, TERRANCE LEE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 GLENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1648
Mailing Address - Country:US
Mailing Address - Phone:724-282-6549
Mailing Address - Fax:724-282-2466
Practice Address - Street 1:313 GLENWOOD WAY
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1648
Practice Address - Country:US
Practice Address - Phone:724-282-6549
Practice Address - Fax:724-282-2466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001575E2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical