Provider Demographics
NPI:1194768325
Name:SIPE, SEAN S (PT, DPT, SCS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:S
Last Name:SIPE
Suffix:
Gender:M
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DENNIS ST SW
Mailing Address - Street 2:STE B
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:360-338-0257
Practice Address - Street 1:4740 AVERY LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5603
Practice Address - Country:US
Practice Address - Phone:360-491-1815
Practice Address - Fax:360-491-1615
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT5393225100000X
WAPT000078542251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA710883456-98512-A002OtherTRICARE
WA7108SIOtherREGENCE BLUE SHIELD
WA8352551Medicaid
WA3456SIOtherREGENCE BLUE SHIELD
WA7796348OtherAETNA
WAGAB29286Medicare PIN
WA710883456-98501-A002OtherTRICARE
WA8834SIOtherREGENCE BLUE SHIELD
WA650023381OtherRAILROAD MEDICARE
WA8936918OtherL&I CRIME VICTIMS
WA0160091OtherDEPT. OF LABOR & INDUSTRY
WA710883456-98503-A004OtherTRICARE