Provider Demographics
NPI:1871724187
Name:SHEEHAN, SUSAN M (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S BRIGGS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-9591
Mailing Address - Country:US
Mailing Address - Phone:815-722-1757
Mailing Address - Fax:815-722-1767
Practice Address - Street 1:989 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-3781
Practice Address - Country:US
Practice Address - Phone:708-946-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-003762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist