Basic Information
| Provider Information | |||||||||
| NPI: | 1366622318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEDILLO | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16700 N THOMPSON PEAK PKWY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806294606 | ||||||||
| FaxNumber: | 4806298511 | ||||||||
| Practice Location | |||||||||
| Address1: | 16700 N THOMPSON PEAK PKWY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806294606 | ||||||||
| FaxNumber: | 4806298511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | AZ3300 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.