Provider Demographics
NPI:1558594853
Name:TANDOC, SERAFIN M (RPT)
Entity Type:Individual
Prefix:MR
First Name:SERAFIN
Middle Name:M
Last Name:TANDOC
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4711
Mailing Address - Country:US
Mailing Address - Phone:317-903-2394
Mailing Address - Fax:
Practice Address - Street 1:445 S COUNTY ROAD 525 E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8361
Practice Address - Country:US
Practice Address - Phone:317-745-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005448A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist