Provider Demographics
NPI:1326751546
Name:SEDLACEK, COLLIN B
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:B
Last Name:SEDLACEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3390
Mailing Address - Country:US
Mailing Address - Phone:206-527-2800
Mailing Address - Fax:206-526-5394
Practice Address - Street 1:2377 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3390
Practice Address - Country:US
Practice Address - Phone:206-527-2800
Practice Address - Fax:206-526-5394
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61221748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist