Mark Nicholas Sullivan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5549024 Issued in WI

Practice address

400 Water Ave
St Josephs Rehab Department
Hillsboro, WI 54634

Phone

(608) 489-8260

Fax

(608) 489-8193

NPI assigned

Oct 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 2

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679653455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 PINE AVE",
            "city": "HILLSBORO",
            "state": "WI",
            "postal_code": "54634",
            "telephone_number": "608-489-2733",
            "fax_number": "608-489-8193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WATER AVE",
            "address_2": "ST JOSEPHS REHAB DEPARTMENT",
            "city": "HILLSBORO",
            "state": "WI",
            "postal_code": "54634",
            "telephone_number": "608-489-8260",
            "fax_number": "608-489-8193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARK",
        "middle_name": "NICHOLAS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "5549024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40475300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPI",
            "identifier": "5415000450861",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Joseph's Health Services, Inc.
• St. Joseph's Health Services, Inc.
• St. Joseph's Health Services, Inc.
• St. Joseph's Health Services, Inc.
• Brandon William Stanek, MS, LAT, ATC
• Jumana Swenson
• Ashley J Thayer, PT
• Jessica Ann Thompson, NP
• Victor A Thonn, O.D.
• Cayle T Tompkins, MD

• Physical Therapist in Hillsboro, WI
• Providers in Hillsboro, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.