Provider Demographics
NPI:1356724637
Name:MANDELL, SEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:MANDELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3861 MISSION AVE STE B25
Mailing Address - Street 2:SUITE B25
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1817
Mailing Address - Country:US
Mailing Address - Phone:760-655-1322
Mailing Address - Fax:760-655-1321
Practice Address - Street 1:3861 MISSION AVENUE
Practice Address - Street 2:SUITE B25
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-9205
Practice Address - Country:US
Practice Address - Phone:760-655-1322
Practice Address - Fax:760-655-1321
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42125225100000X
CAPT42425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist