Provider Demographics
NPI:1992900633
Name:POWERS, SEAN M (PT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:POWERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 SE 105TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4746
Mailing Address - Country:US
Mailing Address - Phone:360-694-7501
Mailing Address - Fax:360-694-8148
Practice Address - Street 1:2911 SE VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8103
Practice Address - Country:US
Practice Address - Phone:360-253-3855
Practice Address - Fax:360-883-3103
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist