Provider Demographics
NPI:1083859136
Name:SEAWELL, SANDRA L (LPT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SEAWELL
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 HULEN ST
Mailing Address - Street 2:STE D
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6808
Mailing Address - Country:US
Mailing Address - Phone:817-377-2535
Mailing Address - Fax:817-292-0572
Practice Address - Street 1:3550 HULEN ST
Practice Address - Street 2:STE D
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6808
Practice Address - Country:US
Practice Address - Phone:817-377-2535
Practice Address - Fax:817-292-0572
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062487225100000X, 2251G0304X, 2251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics