Scott Sullivan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12553 Issued in SC

Practice address

439 Channel Rd Ste 102
Lake Wylie, SC 29710-6101

Phone

(803) 746-7800

NPI assigned

Aug 29, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Focus, Inc.Group PAC ID 5890851406, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Lake Wylie, SC
  • NPI 1518105279

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Rock Hill, SC
  • NPI 1902443880
  NPD

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

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1477070522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412066",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412066",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 CHANNEL RD STE 102",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106101",
            "telephone_number": "803-746-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5320 Mark Dabling Blvd # 100",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809183839",
            "country_code": "US",
            "telephone_number": "719-592-1584",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2322 S Academy Blvd",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809162406",
            "country_code": "US",
            "telephone_number": "719-390-1727",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2675 Court Dr",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280541478",
            "country_code": "US",
            "telephone_number": "704-824-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-29",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "20579",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CO",
            "license": "PTL.0015126",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "12553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "20579",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• SRJ Creative Endeavors, LLC
• Elizabeth R Staines, PT
• Thomas N Stall Sr., DMD
• Katherine Stanton
• Stepping Stones Pediatric Therapy Inc
• TLC Your Way Home Care Services, Inc.
• Jennifer C Todd, OT
• Alexis Rae Tromba, OTR/L
• Chase Tucker, D.P.T
• Jennifer Vespa McGrann, DPT

• Physical Therapist in Lake Wylie, SC
• Providers in Lake Wylie, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.