Provider Demographics
NPI:1831310614
Name:SULLIVAN, IRENE MURPHY (M S, P T)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MURPHY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:M S, P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 TAYLOR ST
Mailing Address - Street 2:GRANBY, MA 01033
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9526
Mailing Address - Country:US
Mailing Address - Phone:413-467-3655
Mailing Address - Fax:
Practice Address - Street 1:9 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1730
Practice Address - Country:US
Practice Address - Phone:413-596-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist