Provider Demographics
NPI:1831509686
Name:SUMPTER, SENA MARIE
Entity type:Individual
Prefix:
First Name:SENA
Middle Name:MARIE
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SENA
Other - Middle Name:MARIE
Other - Last Name:ORNELAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3980 E JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2205
Mailing Address - Country:US
Mailing Address - Phone:816-795-1433
Mailing Address - Fax:
Practice Address - Street 1:3980 E JACKSON DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2205
Practice Address - Country:US
Practice Address - Phone:816-795-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027686225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant