Active NPI
Patrick Sullivan
- Physical Therapy Assistant
- Canton, NC
National Provider Identifier
1932659612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5883
- Practice address
- 100 Silver Bluff Dr
Canton, NC 28716-6350 - Phone
- (828) 648-2044
- NPI assigned
- Oct 6, 2016
- Last updated
- Oct 6, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 | 5883 | NC | Primary |
Addresses
Primary practice location
100 Silver Bluff Dr
Canton, NC 28716-6350
Mailing address
23 Kirby Road
Asheville, NC 28806
Phone (207) 317-7009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 225200000X | Medicaid | NC |
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 |
|---|---|---|---|
| 5883 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475712000000",
"number": "1932659612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 KIRBY ROAD",
"city": "ASHEVILLE",
"state": "NC",
"postal_code": "28806",
"telephone_number": "207-317-7009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SILVER BLUFF DR",
"city": "CANTON",
"state": "NC",
"postal_code": "287166350",
"telephone_number": "828-648-2044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PATRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-06",
"last_updated": "2016-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "5883",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "225200000X",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.