Active NPI
Kevin Sullivan
- Physical Therapy Assistant
- Camarillo, CA
National Provider Identifier
1659258044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 11051
- Practice address
- 450 Rosewood Ave Ste 105
Camarillo, CA 93010-5914 - Phone
- (805) 389-4781
- NPI assigned
- Aug 19, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 11051 | CA | Primary |
Addresses
Primary practice location
450 Rosewood Ave Ste 105
Camarillo, CA 93010-5914
Mailing address
450 Rosewood Ave Ste 105
Camarillo, CA 93010-5914
Phone (805) 389-4781
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 |
|---|---|---|---|
| 11051 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755561600000",
"number": "1659258044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 ROSEWOOD AVE STE 105",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930105914",
"telephone_number": "805-389-4781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 ROSEWOOD AVE STE 105",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930105914",
"telephone_number": "805-389-4781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-19",
"last_updated": "2025-08-19",
"certification_date": "2025-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "11051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.