Provider Demographics
NPI:1770552457
Name:SULLIVAN, THOMAS MORGAN (ATC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MORGAN
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 ALABAMA TRL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1374
Mailing Address - Country:US
Mailing Address - Phone:630-407-0279
Mailing Address - Fax:
Practice Address - Street 1:BUFFALO GROVE HIGH SCHOOL
Practice Address - Street 2:1100 W. DUNDEE RD.
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:847-718-4177
Practice Address - Fax:847-718-4178
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine