Provider Demographics
NPI:1659551992
Name:SEBO, ERIC WADE (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:WADE
Last Name:SEBO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6813 WOOD HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8559
Mailing Address - Country:US
Mailing Address - Phone:317-733-1641
Mailing Address - Fax:317-733-1642
Practice Address - Street 1:6813 WOOD HAVEN PL
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8559
Practice Address - Country:US
Practice Address - Phone:317-733-1641
Practice Address - Fax:317-733-1642
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003967A2251X0800X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics