Most Relevant Information
Provider Data
| NPI Number: | 1003299777 |
| Provider Name: | JAMES SULLIVAN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 5502003968 |
Most Important Dates
| Enumeration Date: | 06/30/2015 |
| Last Updated: | 06/30/2015 |
Provider Practice Location
10821 BOULDERCREST DRIVE
SOUTH LYON
MI
48178
Practice Location Phone/Fax
| Phone: | 3137173291 |
| Fax: |
Provider Mailing Location
10821 BOULDERCREST DRIVE
SOUTH LYON
MI
48178
Provider Mailing Phone/Fax
| Phone: | 3137173291 |
| Fax: |