Healthcare Provider Details

I. General information

NPI: 1538118179
Provider Name (Legal Business Name): SPENCER E SEWELL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WAYLAND SMITH DR SUITE A
UNIONTOWN PA
15401-2677
US

IV. Provider business mailing address

150 WAYLAND SMITH DR SUITE A
UNIONTOWN PA
15401-2677
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-8200
  • Fax: 724-437-6673
Mailing address:
  • Phone: 724-437-8200
  • Fax: 724-437-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0057051
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: