Provider Demographics
NPI:1730318130
Name:SEWELL, LYNNE TIVIDOR (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:TIVIDOR
Last Name:SEWELL
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 1:835 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-6267
Mailing Address - Country:US
Mailing Address - Phone:412-334-8202
Mailing Address - Fax:
Practice Address - Street 1:835 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-6267
Practice Address - Country:US
Practice Address - Phone:412-334-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000728E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist