Provider Demographics
NPI:1811270507
Name:SULLIVAN, CHRISTOPHER MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 BROWN BARK DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2618
Mailing Address - Country:US
Mailing Address - Phone:937-605-5978
Mailing Address - Fax:
Practice Address - Street 1:8412 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1030
Practice Address - Country:US
Practice Address - Phone:937-235-0068
Practice Address - Fax:937-235-1442
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013466208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation