Provider Demographics
NPI:1063409373
Name:SULLIVAN, PAULA A (BS PT)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LINEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2901
Mailing Address - Country:US
Mailing Address - Phone:978-356-4297
Mailing Address - Fax:978-356-5091
Practice Address - Street 1:1 LINEBROOK RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2901
Practice Address - Country:US
Practice Address - Phone:978-356-4297
Practice Address - Fax:978-356-5091
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68201Medicare ID - Type Unspecified