Healthcare Provider Details

I. General information

NPI: 1508810391
Provider Name (Legal Business Name): SHECANNA R SEELEY M.P.T., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHECANNA R WOOMER A.T.C.

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 W MAIN ST
ROBINSON IL
62454-4845
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 618-421-4773
  • Fax: 618-421-4474
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070017039
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010420A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096001797
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001770A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: