Mathew Byron Sullivan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

28874 Issued in CA

Practice address

5152 Katella Ave
Suite 106
Los Alamitos, CA 90720-2817

Phone

(562) 431-6004

Fax

(562) 431-9854

NPI assigned

Feb 25, 2013

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1134469406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5152 KATELLA AVE",
            "address_2": "SUITE 106",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202817",
            "telephone_number": "562-431-6004",
            "fax_number": "562-431-9854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5152 KATELLA AVE",
            "address_2": "SUITE 106",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202817",
            "telephone_number": "562-431-6004",
            "fax_number": "562-431-9854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MATHEW",
        "middle_name": "BYRON",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-25",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "28874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT28874",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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.