Provider Demographics
NPI:1770915159
Name:SEESENGOOD, BROOKE KRISTIN (PT, DPT, CLT)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:KRISTIN
Last Name:SEESENGOOD
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:KRISTIN
Other - Last Name:URFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT
Mailing Address - Street 1:5760 N SHIPLEY RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3957
Mailing Address - Country:US
Mailing Address - Phone:618-302-1164
Mailing Address - Fax:
Practice Address - Street 1:5760 N SHIPLEY RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-3957
Practice Address - Country:US
Practice Address - Phone:618-302-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist