Provider Demographics
NPI:1891977286
Name:SULLIVAN, MERYL (DPT)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MERYL
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:73 NEWTON RD 101
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2440
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:73 NEWTON RD
Practice Address - Street 2:STE 11
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2424
Practice Address - Country:US
Practice Address - Phone:978-388-7272
Practice Address - Fax:978-388-7373
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH32842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic