Provider Demographics
NPI:1679056444
Name:SCULLY, SEAN JOSEPH (DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:JOSEPH
Last Name:SCULLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41125 N DAISY MOUNTAIN DR STE 121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4964
Mailing Address - Country:US
Mailing Address - Phone:480-265-2132
Mailing Address - Fax:623-551-9708
Practice Address - Street 1:9784 W YEARLING RD UNIT 1520
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1379
Practice Address - Country:US
Practice Address - Phone:623-244-0017
Practice Address - Fax:623-412-2118
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
225100000X
AZLPT-30300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist