Provider Demographics
NPI:1053332940
Name:SEDGWICK, DONNA MARIE (MPH PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:SEDGWICK
Suffix:
Gender:F
Credentials:MPH PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 LANTERN RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037
Mailing Address - Country:US
Mailing Address - Phone:317-806-7803
Mailing Address - Fax:317-806-7804
Practice Address - Street 1:10150 LANTERN RD
Practice Address - Street 2:SUITE 225
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037
Practice Address - Country:US
Practice Address - Phone:317-806-7803
Practice Address - Fax:317-806-7804
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008465A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000975568OtherANTHEM
IN000000975568OtherANTHEM