Provider Demographics
NPI:1336281302
Name:MCCORD-SULLIVAN, KAREN JOYCE (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JOYCE
Last Name:MCCORD-SULLIVAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:JOYCE
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3020 CHILDREN'S WAY MC 5068
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5829
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:MC 5068
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist