Healthcare Provider Details

I. General information

NPI: 1821420605
Provider Name (Legal Business Name): SEAN WELLS PT, DPT, GCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 WATERLOO BLVD
EXTON PA
19341-2624
US

IV. Provider business mailing address

390 WATERLOO BLVD
EXTON PA
19341-2624
US

V. Phone/Fax

Practice location:
  • Phone: 484-875-0200
  • Fax:
Mailing address:
  • Phone: 484-875-0200
  • Fax: 484-875-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT022854
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT022854
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: