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General NPI Number Information
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NPI Number | 1679056444
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Entity Type | Individual
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Provider Name | SEAN JOSEPH SCULLY DPT
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Gender | Male
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 9784 W YEARLING RD UNIT 1520
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City | PEORIA
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State | AZ
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Zip | 85383-1379
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Country | US
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Telephone | 623-412-2117
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Fax | 623-412-2118
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Provider Business Mailing Address
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Address Line | 41125 N DAISY MOUNTAIN DR STE 121
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City | PHOENIX
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State | AZ
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Zip | 85086-4964
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Country | US
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Telephone | 480-265-2132
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Fax | 623-551-9708
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | LPT-30300
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License Number State | AZ
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