Healthcare Provider Details

I. General information

NPI: 1912885617
Provider Name (Legal Business Name): BRIDGETT RENEE SEWELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIDGETT SEWELL DPT

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 W WADE HAMPTON BLVD
GREER SC
29650-1167
US

IV. Provider business mailing address

PO BOX 96227
PHOENIX AZ
85072-6227
US

V. Phone/Fax

Practice location:
  • Phone: 864-469-0562
  • Fax: 864-469-0564
Mailing address:
  • Phone: 678-837-7176
  • Fax: 404-777-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP056685T
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24368
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: