Provider Demographics
NPI:1215220629
Name:SULLIVAN, DANIEL (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:350 S COUNTY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4481
Mailing Address - Country:US
Mailing Address - Phone:561-655-3699
Mailing Address - Fax:561-655-4664
Practice Address - Street 1:350 S COUNTY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4481
Practice Address - Country:US
Practice Address - Phone:561-655-3699
Practice Address - Fax:561-655-4664
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist