Lori Sullivan, MSPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

LPT-30750 Issued in AZ

Practice address

6804 S Kings Ranch Rd
Ste 103
Gold Canyon, AZ 85118-2960

Phone

(480) 983-8600

NPI assigned

Jun 25, 2009

Last updated

Sep 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Lori Jo Sullivan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1588892863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6804 S KINGS RANCH RD",
            "address_2": "STE 103",
            "city": "GOLD CANYON",
            "state": "AZ",
            "postal_code": "851182960",
            "telephone_number": "480-983-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6804 S KINGS RANCH RD",
            "address_2": "STE 103",
            "city": "GOLD CANYON",
            "state": "AZ",
            "postal_code": "851182960",
            "telephone_number": "480-983-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207 Fletcher St",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481091050",
            "country_code": "US",
            "telephone_number": "734-764-8349",
            "fax_number": "734-763-1034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LORI",
        "name_prefix": "Ms.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010318",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": "LPT-30750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORI",
            "last_name": "SULLIVAN",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Orthopedic Physical Therapist in Gold Canyon, AZ
• Providers in Gold Canyon, AZ by specialty
• Orthopedic Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; 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.