Provider Demographics
NPI:1639489271
Name:SULLIVAN, KERRI (PT)
Entity type:Individual
Prefix:
First Name:KERRI
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 1:151 FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443
Mailing Address - Country:US
Mailing Address - Phone:845-340-8503
Mailing Address - Fax:
Practice Address - Street 1:151 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443
Practice Address - Country:US
Practice Address - Phone:845-340-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17755-1225100000X
NY017755-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist