| Doctor Name: | MRS. KELLY GOODRICH SULLIVAN |
| NPI Number: | 1053713024 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, PT |
| License Number: | PT9042 |
| Business Practice Address: | 2035 Gayle Pl Clearwater, FL - 337634217 |
| Business Phone Number: | 7274218161 |
| Business Fax Number: | 7274435358 |
| Mailing Address: | 2035 Gayle Pl, CLEARWATER |
| State: | FL |
| Postal Code: | 337634217 |
| Phone Number: | 7274218161 |
| Fax Number: | 7274435358 |
| NPI Enumeration Date: | 09/22/2014 |
| NPI Last Update Date: | 09/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT9042 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| 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 |