Provider Demographics
NPI:1073250353
Name:SEITZ, EDWARD B (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:B
Last Name:SEITZ
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 1:310 W TANSEY XING
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9743
Mailing Address - Country:US
Mailing Address - Phone:317-514-3950
Mailing Address - Fax:
Practice Address - Street 1:10480 GLASSWATER LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-0009
Practice Address - Country:US
Practice Address - Phone:317-514-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006288A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist