Provider Demographics
NPI:1023275849
Name:SULLIVAN, SARA ANN (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 CLYMER SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:NY
Mailing Address - Zip Code:14724-9758
Mailing Address - Country:US
Mailing Address - Phone:716-969-3685
Mailing Address - Fax:
Practice Address - Street 1:631 CLYMER SHERMAN RD
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:NY
Practice Address - Zip Code:14724-9758
Practice Address - Country:US
Practice Address - Phone:716-969-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024114-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist