Provider Demographics
NPI:1235521352
Name:SEARS, WILLIAM J (LMT, ADS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:SEARS
Suffix:
Gender:M
Credentials:LMT, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62245-2124
Mailing Address - Country:US
Mailing Address - Phone:618-523-1002
Mailing Address - Fax:
Practice Address - Street 1:811 BROADWAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1801
Practice Address - Country:US
Practice Address - Phone:618-654-3900
Practice Address - Fax:618-654-1707
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227004506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist