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General NPI Number Information
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NPI Number | 1104001247
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Entity Type | Individual
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Provider Name | WILLIAM TYSON SELLERS PT
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Gender | Male
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 156 S MAIN ST SUITE 200
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City | LUMBERTON
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State | TX
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Zip | 77657-7881
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Country | US
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Telephone | 409-658-9369
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Fax |
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Provider Business Mailing Address
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Address Line | 250 S ARCHIE ST
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City | VIDOR
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State | TX
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Zip | 77662-4839
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Country | US
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Telephone | 409-422-0606
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Fax | 888-804-5430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1139889
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License Number State | TX
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