Provider Demographics
NPI:1922653245
Name:SULLIVAN, LINDSAY MAE (DPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MAE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WEDGEWOOD DR APT 81
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-4115
Mailing Address - Country:US
Mailing Address - Phone:518-321-4284
Mailing Address - Fax:
Practice Address - Street 1:223 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3132
Practice Address - Country:US
Practice Address - Phone:201-666-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist