Provider Demographics
NPI:1417476300
Name:TU, SHAUN (PT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:TU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 N HONORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-0097
Mailing Address - Country:US
Mailing Address - Phone:650-387-2323
Mailing Address - Fax:
Practice Address - Street 1:2659 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3013
Practice Address - Country:US
Practice Address - Phone:773-252-4921
Practice Address - Fax:773-252-5067
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X
IL070.022961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics