Provider Demographics
NPI:1982043048
Name:SEDENU, BAYO U (PT, PHD)
Entity Type:Individual
Prefix:DR
First Name:BAYO
Middle Name:U
Last Name:SEDENU
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LOW WATER WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7079
Mailing Address - Country:US
Mailing Address - Phone:678-894-5628
Mailing Address - Fax:770-559-7538
Practice Address - Street 1:1301 LOW WATER WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7079
Practice Address - Country:US
Practice Address - Phone:678-894-5628
Practice Address - Fax:770-559-7538
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14243225100000X
GAPT011267225100000X
FLPT 28335225100000X
NY010854-1225100000X
SC7061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT011267OtherBOARD OF PHYSICAL THERAPY