Provider Demographics
NPI:1265583793
Name:SULLIVAN, MEGAN (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
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 1:7800 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5528
Mailing Address - Country:US
Mailing Address - Phone:305-779-2427
Mailing Address - Fax:305-779-2437
Practice Address - Street 1:7800 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5528
Practice Address - Country:US
Practice Address - Phone:305-779-2427
Practice Address - Fax:305-779-2437
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36441225100000X
WAPT00009862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist