Provider Demographics
NPI:1205032646
Name:TATUM, SETH (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:TATUM
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19310 E 50TH TER S
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5564
Mailing Address - Country:US
Mailing Address - Phone:816-795-1507
Mailing Address - Fax:816-795-1533
Practice Address - Street 1:19310 E 50TH TER S
Practice Address - Street 2:SUITE A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5564
Practice Address - Country:US
Practice Address - Phone:816-795-1507
Practice Address - Fax:816-795-1533
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05562225100000X
MO2016019546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist