CHARLES BLAKE SULLIVAN

PADUCAH, KY
NPI1821562612
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: KY  007479)
Enumeration Date2019-01-15
Last Update Date2019-01-15
Business Address
-- CHARLES BLAKE SULLIVAN DPT
4645 VILLAGE SQUARE DR STE A
PADUCAH, KY 42001-7448
Phone number: 270-443-5712
Mailing Address
-- CHARLES BLAKE SULLIVAN DPT
2255 OWENS CHAPEL RD
MELBER, KY 42069-8814
Phone number: 270-703-4992
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