| Doctor Name: | MR. TODD MICHAEL SULLIVAN |
| NPI Number: | 1003982711 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT |
| License Number: | 05008436A |
| Business Practice Address: | 7930 W Jefferson Blvd Fort Wayne, IN - 468044140 |
| Business Phone Number: | 2604325800 |
| Business Fax Number: | 2604329555 |
| Mailing Address: | 4251 Lahmeyer Rd, FORT WAYNE |
| State: | IN |
| Postal Code: | 468155676 |
| Phone Number: | 2604324700 |
| Fax Number: | 2604599262 |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 04/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05008436A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |