Healthcare Provider Details

I. General information

NPI: 1558641365
Provider Name (Legal Business Name): ANDREW ROBERT SELLS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 HOSPITALITY LN SUITE 1
MINERAL WELLS WV
26150-6704
US

IV. Provider business mailing address

415 36TH ST SUITE 100
PARKERSBURG WV
26101-1005
US

V. Phone/Fax

Practice location:
  • Phone: 304-489-8100
  • Fax: 304-489-8191
Mailing address:
  • Phone: 304-917-3660
  • Fax: 304-917-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002966
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: