Provider Demographics
NPI:1366330771
Name:WILLIFORD, SEAN
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:WILLIFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 OAK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2556
Mailing Address - Country:US
Mailing Address - Phone:713-376-7656
Mailing Address - Fax:
Practice Address - Street 1:400 S RANDALL RD STE C
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4607
Practice Address - Country:US
Practice Address - Phone:224-273-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.029236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist