Provider Demographics
NPI:1104001247
Name:SELLERS, WILLIAM TYSON (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TYSON
Last Name:SELLERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S ARCHIE ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-4839
Mailing Address - Country:US
Mailing Address - Phone:409-422-0606
Mailing Address - Fax:888-804-5430
Practice Address - Street 1:156 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7881
Practice Address - Country:US
Practice Address - Phone:409-658-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist