Provider Demographics
NPI:1396006474
Name:MCELFRESH, SEAN MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:MCELFRESH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1590 STRINGTOWN RD
Practice Address - Street 2:UNIT 21
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9832
Practice Address - Country:US
Practice Address - Phone:614-594-5341
Practice Address - Fax:614-539-2952
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075593Medicaid