Doctor Name: | DR. MATHEW BYRON SULLIVAN |
NPI Number: | 1134469406 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 28874 |
Business Practice Address: | 823 W 24th St Apt 2 San Pedro, CA - 907315800 |
Business Phone Number: | 3107950577 |
Business Fax Number: | |
Mailing Address: | 823 W 24th St Apt 2, SAN PEDRO |
State: | CA |
Postal Code: | 907315800 |
Phone Number: | 3107950577 |
Fax Number: | |
NPI Enumeration Date: | 02/25/2013 |
NPI Last Update Date: | 02/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 28874 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |