Provider Demographics
NPI:1407448673
Name:SEDLACEK, LINDA M (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 TUNNEL MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9393
Mailing Address - Country:US
Mailing Address - Phone:502-773-0879
Mailing Address - Fax:
Practice Address - Street 1:4107 TUNNEL MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9393
Practice Address - Country:US
Practice Address - Phone:502-773-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008795A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist