Healthcare Provider Details

I. General information

NPI: 1689402158
Provider Name (Legal Business Name): BRENDEN SEKI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 EWING AVE
EVANSTON IL
60201-1214
US

IV. Provider business mailing address

1500 SHERMAN AVE APT 806
EVANSTON IL
60201-4540
US

V. Phone/Fax

Practice location:
  • Phone: 847-905-0332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.028388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: