Provider Demographics
NPI:1710126685
Name:SEDORY, EDWARD (ATC, EMT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SEDORY
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 ALBERTA DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24164 MONTEZUMA AVE
Practice Address - Street 2:THE BASIC SCHOOL - S3/ ATR
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5123
Practice Address - Country:US
Practice Address - Phone:703-784-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB061117703146N00000X
VA01260007782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic