Provider Demographics
NPI:1740708544
Name:ENNIS, SEAN STEVEN (MS,LAT, ATC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:STEVEN
Last Name:ENNIS
Suffix:
Gender:M
Credentials:MS,LAT, ATC
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:STEVEN
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2331 CURRANT ST
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-9805
Mailing Address - Country:US
Mailing Address - Phone:980-474-7048
Mailing Address - Fax:
Practice Address - Street 1:16443 NELSON PARK DR APT 104
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-5859
Practice Address - Country:US
Practice Address - Phone:980-474-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0061282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer