Healthcare Provider Details

I. General information

NPI: 1083859136
Provider Name (Legal Business Name): SANDRA L SEAWELL LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HULEN ST STE D
FORT WORTH TX
76107-6808
US

IV. Provider business mailing address

3550 HULEN ST STE D
FORT WORTH TX
76107-6808
US

V. Phone/Fax

Practice location:
  • Phone: 817-377-2535
  • Fax: 817-292-0572
Mailing address:
  • Phone: 817-377-2535
  • Fax: 817-292-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1062487
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1062487
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1062487
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1062487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: