Provider Demographics
NPI:1962738989
Name:SELLERS, DUSTIN W (DPT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:W
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-3510
Mailing Address - Country:US
Mailing Address - Phone:315-528-4533
Mailing Address - Fax:
Practice Address - Street 1:178 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5144
Practice Address - Country:US
Practice Address - Phone:518-254-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist