Active NPI
Michelle Yvette Sullivan, DPT
- Specialist
- Pasadena, CA
National Provider Identifier
1003040858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT27523
- Practice address
- 288 Atchison St
Pasadena, CA 91104-1002 - Phone
- (626) 798-4050
- Fax
- (626) 798-4050
- NPI assigned
- May 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT27523 | CA | Primary |
Addresses
Primary practice location
288 Atchison St
Pasadena, CA 91104-1002
Mailing address
288 Atchison St
Pasadena, CA 91104-1002
Phone (626) 798-4050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT27523 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241740800000",
"number": "1003040858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "288 ATCHISON ST",
"city": "PASADENA",
"state": "CA",
"postal_code": "911041002",
"telephone_number": "626-798-4050",
"fax_number": "626-798-4050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "288 ATCHISON ST",
"city": "PASADENA",
"state": "CA",
"postal_code": "911041002",
"telephone_number": "626-798-4050",
"fax_number": "626-798-4050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHELLE",
"middle_name": "YVETTE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-08",
"last_updated": "2009-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "PT27523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.