Provider Demographics
NPI:1366333585
Name:SULLIVAN, REBECCA (DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
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 1:4550 SE FEDERAL HWY APT 3101
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5771
Mailing Address - Country:US
Mailing Address - Phone:615-426-5742
Mailing Address - Fax:
Practice Address - Street 1:801 S OLIVE AVE STE 106
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6127
Practice Address - Country:US
Practice Address - Phone:561-461-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist