Provider Demographics
NPI:1861649279
Name:SULLIVAN MUNSELL, ERIN (MPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SULLIVAN MUNSELL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:STEPHANIE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1995 S MAIN ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6637
Mailing Address - Country:US
Mailing Address - Phone:540-951-2703
Mailing Address - Fax:540-953-0873
Practice Address - Street 1:1995 S MAIN ST
Practice Address - Street 2:SUITE 801
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6637
Practice Address - Country:US
Practice Address - Phone:540-951-2703
Practice Address - Fax:540-953-0873
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist