Provider Demographics
NPI:1326022070
Name:SELLERS, AMY RENA (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RENA
Last Name:SELLERS
Suffix:
Gender:F
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:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0922
Mailing Address - Country:US
Mailing Address - Phone:866-309-5567
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:5828 PEARL DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-8116
Practice Address - Country:US
Practice Address - Phone:812-437-1420
Practice Address - Fax:812-437-1425
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003205A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818590Medicaid
IN000000280210OtherBLUE CROSS BLUE SHIELD
IN200818590Medicaid
IN216070XXMedicare PIN