Provider Demographics
NPI:1962924415
Name:SULTAN, IMAD S (LMT)
Entity type:Individual
Prefix:
First Name:IMAD
Middle Name:S
Last Name:SULTAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 BLUEBIRD DR STE B
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2303
Mailing Address - Country:US
Mailing Address - Phone:615-448-6446
Mailing Address - Fax:615-467-8825
Practice Address - Street 1:313 BLUEBIRD DR STE B
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2303
Practice Address - Country:US
Practice Address - Phone:615-448-6446
Practice Address - Fax:615-467-8825
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist