Healthcare Provider Details

I. General information

NPI: 1891160156
Provider Name (Legal Business Name): JEFFREY BRANDON SELLS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 E BROWN RD STE 104
MESA AZ
85207-3759
US

IV. Provider business mailing address

1844 E BASELINE RD STE C5
TEMPE AZ
85283-1506
US

V. Phone/Fax

Practice location:
  • Phone: 480-779-4671
  • Fax: 480-631-7783
Mailing address:
  • Phone: 480-833-1005
  • Fax: 480-833-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-010978
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: