Provider Demographics
NPI:1285064584
Name:SULLIVAN, DIANNA (DPT)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHESTNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1472
Mailing Address - Country:US
Mailing Address - Phone:781-551-5812
Mailing Address - Fax:
Practice Address - Street 1:16 CHESTNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1472
Practice Address - Country:US
Practice Address - Phone:781-551-5812
Practice Address - Fax:508-698-8671
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist