Provider Demographics
NPI:1275595936
Name:MONTEYNE, SEAN JAMES (ATC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:JAMES
Last Name:MONTEYNE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 RUTLEDGE PL
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4422
Mailing Address - Country:US
Mailing Address - Phone:217-617-6993
Mailing Address - Fax:
Practice Address - Street 1:3014 RUTLEDGE PL
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4422
Practice Address - Country:US
Practice Address - Phone:217-617-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.001449174400000X
119702589174400000X
IL160.006970225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No174400000XOther Service ProvidersSpecialist