| Doctor Name: | KEITH EDWARD SULLIVAN |
| NPI Number: | 1164823738 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | 37244 |
| Business Practice Address: | 1001 Sneath Ln San Bruno, CA - 940662308 |
| Business Phone Number: | 6508718645 |
| Business Fax Number: | |
| Mailing Address: | 1717 Los Altos Dr, SAN MATEO |
| State: | CA |
| Postal Code: | 944023602 |
| Phone Number: | 6502009600 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2014 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 37244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |