Provider Demographics
NPI:1194734491
Name:SULLIVAN, THERESA K
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:K
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:GLADHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7900 E GREEN LAKE DR N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4800
Mailing Address - Country:US
Mailing Address - Phone:206-985-2236
Mailing Address - Fax:206-985-2248
Practice Address - Street 1:7900 E GREEN LAKE DR N
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4800
Practice Address - Country:US
Practice Address - Phone:206-985-2236
Practice Address - Fax:206-985-2248
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27565Medicare ID - Type Unspecified
WAP54498Medicare UPIN