Provider Demographics
NPI:1922831650
Name:EDMONDS, SEAN CHRISTOPHER (PT, DPT, LAT, CSCS)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:PT, DPT, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HAINES AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3419
Mailing Address - Country:US
Mailing Address - Phone:330-840-4238
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY STE 160
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7989
Practice Address - Country:US
Practice Address - Phone:614-776-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist