Healthcare Provider Details

I. General information

NPI: 1386873248
Provider Name (Legal Business Name): JORI L SHEA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORI L SEYMOUR MPT

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N ARLINGTON HEIGHTS RD SUITE 170
BUFFALO GROVE IL
60089-1783
US

IV. Provider business mailing address

165 N ARLINGTON HEIGHTS RD SUITE 170
BUFFALO GROVE IL
60089-1783
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-0450
  • Fax: 224-676-0448
Mailing address:
  • Phone: 224-676-0450
  • Fax: 224-676-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010526
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11584-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: