MEDICARE: ETHAN SEDMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0013537	CO

General Provider Information

NPI Number	:	1376911594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN SEDMAN

Provider Business Mailing Address
First Line	:	9320 GRAND CORDERA PKWY
Second Line	:	SUITE 125
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7003
Country	:	US
Telephone Number	:	719-535-2757
Fax Number	:	719-535-2767

Provider Business Practice Location Address
First Line	:	9320 GRAND CORDERA PKWY
Second Line	:	SUITE 125
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7003
Country	:	US
Telephone Number	:	719-535-2757
Fax Number	:	719-535-2767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	02/25/2016

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Directions to “ ETHAN SEDMAN ” Practice Location

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