Provider Demographics
NPI:1487973327
Name:SULGROVE, JOHN L (MPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:SULGROVE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 S EASTERN AVE
Mailing Address - Street 2:SUITE 5-406
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1507
Mailing Address - Country:US
Mailing Address - Phone:702-326-3273
Mailing Address - Fax:
Practice Address - Street 1:7435 S EASTERN AVE
Practice Address - Street 2:SUITE 5-406
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1507
Practice Address - Country:US
Practice Address - Phone:702-326-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist