Provider Demographics
NPI:1356778088
Name:SULLIVAN, COURTNEY ALLISON (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALLISON
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ALLISON
Other - Last Name:SINCLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:291 E MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6137
Mailing Address - Country:US
Mailing Address - Phone:408-354-2223
Mailing Address - Fax:408-979-2301
Practice Address - Street 1:291 E MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6137
Practice Address - Country:US
Practice Address - Phone:408-354-2223
Practice Address - Fax:408-979-2301
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist