Provider Demographics
NPI:1457712945
Name:WOODFORD, SEAN LINDSAY (ATS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:LINDSAY
Last Name:WOODFORD
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4146
Mailing Address - Country:US
Mailing Address - Phone:815-901-1010
Mailing Address - Fax:
Practice Address - Street 1:833 ELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4146
Practice Address - Country:US
Practice Address - Phone:815-901-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer