NPI 1003299777

James Sullivan, PTA

Practitioner Physical Therapy Assistant South Lyon, MI

Practice location

Address: 10821 Bouldercrest Drive, South Lyon, MI 48178
Phone: (313) 717-3291

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence 5502003968 (MI)

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Registry record

NPI: 1003299777
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jun 2015
Record last updated: 30 Jun 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.