Healthcare Provider Details

I. General information

NPI: 1861173429
Provider Name (Legal Business Name): KELLY SEKHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 SHOWPLACE DR UNIT 10
NAPERVILLE IL
60564-5046
US

IV. Provider business mailing address

2507 WINTER PARK CT
NAPERVILLE IL
60565-5369
US

V. Phone/Fax

Practice location:
  • Phone: 630-856-6475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.023860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: