Healthcare Provider Details

I. General information

NPI: 1528213956
Provider Name (Legal Business Name): JAMES A SEALS C.PED, RTO, CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-0000
US

IV. Provider business mailing address

1481 W 10TH ST
INDIANAPOLIS IN
46202-0000
US

V. Phone/Fax

Practice location:
  • Phone: 310-988-4198
  • Fax:
Mailing address:
  • Phone: 310-988-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: