| NPI | 1265713887 |
|---|---|
| Former Name | SUSAN SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 003963) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 007023) |
| 225100000X Physical Therapist (Licence: NH 001073) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |