Provider Demographics
NPI:1033540869
Name:SEDHOM, ALFRED (DPT)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:SEDHOM
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 1:10560 MAIN ST STE PS10
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7119
Mailing Address - Country:US
Mailing Address - Phone:703-659-0280
Mailing Address - Fax:703-659-0280
Practice Address - Street 1:10560 MAIN ST STE PS10
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7119
Practice Address - Country:US
Practice Address - Phone:703-659-0280
Practice Address - Fax:703-659-0280
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist