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Contact Information

JACQUELINE D SULLIVAN, PTA ATRIC
15884 MANCHESTER RD
ELLISVILLE, MO63011
 Phone: 636-391-5400
 Fax: 636-394-9674
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapy Assistant

225200000X
Indicates primary specialty

NPI Profile & details for JACQUELINE D SULLIVAN · (Female)

NPI Number 1235230400
Status Active
Credentials PTA ATRIC
Entity Individual
Enumeration date 09/26/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 2000161113
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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