Active NPI
Robert Patrick Sullivan
- Physical Therapy Assistant
- Rio Rancho, NM
National Provider Identifier
1871087171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A1433
- Practice address
- 2410 19TH St SE
Rio Rancho, NM 87124-4857 - Phone
- (505) 452-4200
- NPI assigned
- Jun 19, 2018
- 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 | A1433 | NM | Primary |
Addresses
Primary practice location
2410 19TH St SE
Rio Rancho, NM 87124-4857
Mailing address
2410 19TH St SE
Rio Rancho, NM 87124-4857
Phone (505) 452-4200
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 |
|---|---|---|---|
| A1433 | NM | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529366400000",
"number": "1871087171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2410 19TH ST SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871244857",
"telephone_number": "505-452-4200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2410 19TH ST SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871244857",
"telephone_number": "505-452-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ROBERT",
"middle_name": "PATRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-19",
"last_updated": "2018-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NM",
"license": "A1433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.