Provider Demographics
NPI:1073952727
Name:CLEARY, SHAYNE MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:MARIE
Last Name:CLEARY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2304
Mailing Address - Country:US
Mailing Address - Phone:312-877-5101
Mailing Address - Fax:312-877-5906
Practice Address - Street 1:1131 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2304
Practice Address - Country:US
Practice Address - Phone:312-877-5101
Practice Address - Fax:312-877-5906
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-021431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist