MEDICARE: BECKY SELLERS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	00873	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154320281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY SELLERS PT

Provider Business Mailing Address
First Line	:	1515 LAWRIE TATUM RD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73507
Country	:	US
Telephone Number	:	580-353-0350
Fax Number	:	580-355-6234

Provider Business Practice Location Address
First Line	:	1515 LAWRIE TATUM RD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73507
Country	:	US
Telephone Number	:	580-353-0350
Fax Number	:	580-355-6234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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Directions to “ BECKY SELLERS PT” Practice Location

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