Provider Demographics
NPI:1871683938
Name:LIM SEBASTIAN, MERCEDES E (LPT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:E
Last Name:LIM SEBASTIAN
Suffix:
Gender:F
Credentials:LPT
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:
Practice Address - Street 1:1920 N RICHMOND RD
Practice Address - Street 2:SUITE A
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5467
Practice Address - Country:US
Practice Address - Phone:815-271-6811
Practice Address - Fax:815-344-8814
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232425OtherBC/BS
ILK03962Medicare ID - Type UnspecifiedMEDICARE LOCALITY 16
ILK03961Medicare ID - Type UnspecifiedMEDDICARE LOCALITY 15
ILP00084698Medicare ID - Type UnspecifiedRAILROAD MEDICARE