MEDICARE: SEAN JOSEPH SCULLY DPT

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
2	208100000X	Physical Medicine & Rehabilitation Physician	LPT-30300	AZ

General Provider Information

NPI Number	:	1679056444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN JOSEPH SCULLY DPT

Provider Business Mailing Address
First Line	:	41125 N DAISY MOUNTAIN DR STE 121
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-4964
Country	:	US
Telephone Number	:	480-265-2132
Fax Number	:	623-551-9708

Provider Business Practice Location Address
First Line	:	9784 W YEARLING RD UNIT 1520
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1379
Country	:	US
Telephone Number	:	623-412-2117
Fax Number	:	623-412-2118

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	05/07/2025

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Directions to “ SEAN JOSEPH SCULLY DPT” Practice Location

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