Provider Demographics
NPI:1699524074
Name:SULLIVAN, LAUREN MARCELLA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARCELLA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 ARBORLAWN DR APT 1350
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3257
Mailing Address - Country:US
Mailing Address - Phone:301-875-4489
Mailing Address - Fax:
Practice Address - Street 1:7217 TELECOM PKWY FL 2
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2202
Practice Address - Country:US
Practice Address - Phone:972-495-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist