Provider Demographics
NPI:1184177719
Name:SULLIVAN, ERIN M
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1642 OLIVE BRANCH PARKE LN
Practice Address - Street 2:#1100
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9821
Practice Address - Country:US
Practice Address - Phone:317-882-2550
Practice Address - Fax:317-882-2551
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant