Provider Demographics
NPI:1508810391
Name:SEELEY, SHECANNA R (MPT, ATC)
Entity Type:Individual
Prefix:
First Name:SHECANNA
Middle Name:R
Last Name:SEELEY
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:SHECANNA
Other - Middle Name:R
Other - Last Name:WOOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
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 1:1718 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-4845
Practice Address - Country:US
Practice Address - Phone:618-421-4773
Practice Address - Fax:618-421-4474
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960017972255A2300X
IN36001770A2255A2300X
IL070017039225100000X
IN05010420A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer