Provider Demographics
NPI:1770609141
Name:SENTELL, SUSAN REBECCA (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:REBECCA
Last Name:SENTELL
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 1:240 HULON HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9091
Mailing Address - Country:US
Mailing Address - Phone:864-457-5147
Mailing Address - Fax:
Practice Address - Street 1:619 LAUREL LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-7451
Practice Address - Country:US
Practice Address - Phone:828-894-3895
Practice Address - Fax:828-894-3709
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2099225100000X
SC668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079MFOtherBCBS OF NC INSURANCE PROV