Provider Demographics
NPI:1770844003
Name:SELLERS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SELLERS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-739-9748
Mailing Address - Street 1:106 VILLAGE TREE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5754
Mailing Address - Country:US
Mailing Address - Phone:337-739-9748
Mailing Address - Fax:
Practice Address - Street 1:1042 CAMELLIA BLVD
Practice Address - Street 2:SUITE # 16
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6680
Practice Address - Country:US
Practice Address - Phone:337-739-9748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty