=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144550500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASSIE RENEE SEAL DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2010
-----------------------------------------------------
Last Update Date | 11/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5178 FRANKLIN ST
-----------------------------------------------------
City | MICHIGAN CITY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46360-7878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-879-2523
-----------------------------------------------------
Fax | 219-879-5162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 790 REMINGTON BLVD
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-296-2223
-----------------------------------------------------
Fax | 630-759-9510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 05009964A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------