| NPI | 1396055810 |
|---|---|
| Former Name | KELLY A. SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 010347) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206636) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2015-03-24 |