Provider Demographics
NPI:1851533145
Name:SULLIVAN, DEBRA K (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 BAD ROCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-9210
Mailing Address - Country:US
Mailing Address - Phone:406-892-0457
Mailing Address - Fax:
Practice Address - Street 1:175 COMMONS LOOP
Practice Address - Street 2:STE 100
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1904
Practice Address - Country:US
Practice Address - Phone:406-752-7250
Practice Address - Fax:406-752-6250
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist