Provider Demographics
NPI:1669597142
Name:SULLIVAN REHABILITATION & SPORTS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:SULLIVAN REHABILITATION & SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-268-5585
Mailing Address - Street 1:106 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1542
Mailing Address - Country:US
Mailing Address - Phone:812-268-5585
Mailing Address - Fax:812-268-0537
Practice Address - Street 1:106 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1542
Practice Address - Country:US
Practice Address - Phone:812-268-5585
Practice Address - Fax:812-268-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty