Basic Information
| Provider Information | |||||||||
| NPI: | 1154428464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SENDZIK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7412 LAS PALMAS DR NE | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493419581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169161347 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 S LACHANCE RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496518022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317753081 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501016104 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 50046054 | 01 | PA | CAPTIAL BLUE CROSS | OTHER | 257173 | 01 | PA | HEALTH AMERICA | OTHER | SE1761922 | 01 | PA | BLUE SHIELD | OTHER |