Individual provider · NPI-1
Ryan Esley Sullivan, LMT
Mechanotherapist · Tallahassee, FL
NPI number1396149944
StatusActive
Last updated in NPPESOct 10, 2014
Details
- NPI
- 1396149944
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ryan Esley Sullivan
- Credential
- LMT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 10, 2014
- Last updated
- Oct 10, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 172M00000X | Mechanotherapist | MA50406 | FL | Yes |
Practice location
325 John Knox Rd Bldg T Ste 1Tallahassee, FL 32303-4166
Phone 850-545-3949
Mailing address
2332 Vinkara DrTallahassee, FL 32303-3724
Phone 850-545-3949
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