MEDICARE: SPENCER E SEWELL 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	PT0057051	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680873	OTHER	PW	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1538118179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER E SEWELL PT

Provider Business Mailing Address
First Line	:	150 WAYLAND SMITH DR
Second Line	:	SUITE A
City	:	UNIONTOWN
State	:	PA
Zip	:	15401-2677
Country	:	US
Telephone Number	:	724-437-8200
Fax Number	:	724-437-6673

Provider Business Practice Location Address
First Line	:	150 WAYLAND SMITH DR
Second Line	:	SUITE A
City	:	UNIONTOWN
State	:	PA
Zip	:	15401-2677
Country	:	US
Telephone Number	:	724-437-8200
Fax Number	:	724-437-6673

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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Directions to “ SPENCER E SEWELL PT” Practice Location

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