Sean David Sullivan, PTA/L

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3586 Issued in MA

Practice address

804 Pleasant St
Brockton, MA 02301-3055

Phone

(508) 583-6000

NPI assigned

Nov 17, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1114294329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 BISCAYNE AVE",
            "city": "WEYMOUTH",
            "state": "MA",
            "postal_code": "021883025",
            "telephone_number": "781-682-9148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 PLEASANT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023013055",
            "telephone_number": "508-583-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SEAN",
        "middle_name": "DAVID",
        "credential": "PTA/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-17",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MA",
            "license": "3586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Luizzi Sullivan, P.A.
• Mark Andrew Sullivan, LICSW
• Matthew Daley Sullivan, PA
• Meghan Elizabeth Sullivan
• Patrick James Sullivan, PA
• William J Sullivan
• Joanna Ogilvy Sumcizk, LCSW
• Deborah D Summers, PNP
• Garmai Suah Sumo
• Moses Etim Sunday

• Physical Therapy Assistant in Brockton, MA
• Providers in Brockton, MA by specialty
• Physical Therapy Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.