MEDICARE: MANDY SELLERS ALDOUS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6519	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972556421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY SELLERS ALDOUS PT

Provider Business Mailing Address
First Line	:	4463 E CARRIAGE WAY
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-5507
Country	:	US
Telephone Number	:	480-459-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3592 S ATHERTON BLVD STE. 110
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7444
Country	:	US
Telephone Number	:	480-840-6777
Fax Number	:	480-840-6778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/20/2015

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