Provider Demographics
NPI:1154428464
Name:SENDZIK, JAMES ERIC (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:SENDZIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7412 LAS PALMAS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9581
Mailing Address - Country:US
Mailing Address - Phone:616-916-1347
Mailing Address - Fax:
Practice Address - Street 1:1900 S LACHANCE RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8022
Practice Address - Country:US
Practice Address - Phone:231-775-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50046054OtherCAPTIAL BLUE CROSS
PA257173OtherHEALTH AMERICA
PASE1761922OtherBLUE SHIELD