Provider Demographics
NPI:1750498002
Name:SEATON, SHIRLEE SUE (PT)
Entity Type:Individual
Prefix:
First Name:SHIRLEE
Middle Name:SUE
Last Name:SEATON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7331
Mailing Address - Country:US
Mailing Address - Phone:505-356-1631
Mailing Address - Fax:
Practice Address - Street 1:1429 S AVENUE D
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6837
Practice Address - Country:US
Practice Address - Phone:505-356-4888
Practice Address - Fax:505-359-3108
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP16520OtherMOLINA ID
NM2387OtherLOVELACE ID
NM006OtherHCH ID
NMNM00Q005OtherBLUE CROSS ID