Basic Information
Provider Information
NPI: 1891807681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEBBY
FirstName: ERIK
MiddleName: D
NamePrefix: MR.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21701 76TH AVE W
Address2: SUITE #304
City: EDMONDS
State: WA
PostalCode: 98026
CountryCode: US
TelephoneNumber: 4257441717
FaxNumber: 4257441736
Practice Location
Address1: 21701 76TH AVE W
Address2: SUITE #304
City: EDMONDS
State: WA
PostalCode: 98026
CountryCode: US
TelephoneNumber: 4257441717
FaxNumber: 4257441736
Other Information
ProviderEnumerationDate: 08/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT00000996WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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