| Doctor Name: | MR. MARK ALLEN SULLIVAN |
| NPI Number: | 1306874227 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MBA, PT, ATC |
| License Number: | 003846 |
| Business Practice Address: | 133 Mountain Rd Suite 2b. Suffield, CT - 060782084 |
| Business Phone Number: | 8602545982 |
| Business Fax Number: | |
| Mailing Address: | 40 Hearthstone Dr, AGAWAM |
| State: | MA |
| Postal Code: | 010013238 |
| Phone Number: | 4137892168 |
| Fax Number: | 8602545982 |
| NPI Enumeration Date: | 06/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 003846 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CT |
| 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 |