Provider Demographics
NPI:1104030329
Name:SESTOSO, HZLE TEJANO (PT)
Entity Type:Individual
Prefix:
First Name:HZLE
Middle Name:TEJANO
Last Name:SESTOSO
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 1:8001 LINDBERGH DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-6859
Mailing Address - Country:US
Mailing Address - Phone:765-749-6425
Mailing Address - Fax:
Practice Address - Street 1:3400 W COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5459
Practice Address - Country:US
Practice Address - Phone:765-289-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008776A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist