Provider Demographics
NPI:1487638920
Name:LO, SHELDON (DPT, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DPT, MS, ATC
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:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:3008 S HALSTED ST
Practice Address - Street 2:SUITE 116
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5805
Practice Address - Country:US
Practice Address - Phone:312-842-1205
Practice Address - Fax:312-842-1356
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL96001009146D00000X
IL070-012654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487638920Medicare NSC
IL1487638920Medicare PIN