Provider Demographics
NPI:1972620920
Name:SEWELL, STEVEN RAY (ATC LAT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RAY
Last Name:SEWELL
Suffix:
Gender:M
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2331
Mailing Address - Country:US
Mailing Address - Phone:256-366-6057
Mailing Address - Fax:
Practice Address - Street 1:219 HOWELL ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2331
Practice Address - Country:US
Practice Address - Phone:256-366-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer