Provider Demographics
NPI:1194896449
Name:SULLIVAN, CHRISTOPHER WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 FAIRCHILD AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-1814
Mailing Address - Country:US
Mailing Address - Phone:330-968-4943
Mailing Address - Fax:330-968-4944
Practice Address - Street 1:1290 FAIRCHILD AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1814
Practice Address - Country:US
Practice Address - Phone:330-968-4943
Practice Address - Fax:330-968-4944
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist