Provider Demographics
NPI:1366622318
Name:SEDILLO, RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:SEDILLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 N THOMPSON PEAK PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2384
Mailing Address - Country:US
Mailing Address - Phone:480-629-4606
Mailing Address - Fax:480-629-8511
Practice Address - Street 1:16700 N THOMPSON PEAK PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2384
Practice Address - Country:US
Practice Address - Phone:480-629-4606
Practice Address - Fax:480-629-8511
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103815Medicare PIN