Healthcare Provider Details

I. General information

NPI: 1992900633
Provider Name (Legal Business Name): SEAN M POWERS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 SE VILLAGE LOOP
VANCOUVER WA
98683-8103
US

IV. Provider business mailing address

1303 SE 105TH CT
VANCOUVER WA
98664-4746
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-3855
  • Fax: 360-883-3103
Mailing address:
  • Phone: 360-694-7501
  • Fax: 360-694-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7295
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: