Basic Information
| Provider Information | |||||||||
| NPI: | 1871735225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEDAS | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | ANDREA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14374 REFLECTION LAKES DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394101024 | ||||||||
| FaxNumber: | 2394816654 | ||||||||
| Practice Location | |||||||||
| Address1: | 7460 LAKE BREEZE DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339078090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394816615 | ||||||||
| FaxNumber: | 2394816654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 04/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20799 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.