Provider Demographics
NPI:1780981365
Name:SHEA PHYSICAL THERAPY LTD.
Entity type:Organization
Organization Name:SHEA PHYSICAL THERAPY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:BRENDAN
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-676-0450
Mailing Address - Street 1:165 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1783
Mailing Address - Country:US
Mailing Address - Phone:224-676-0450
Mailing Address - Fax:224-676-0448
Practice Address - Street 1:165 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1783
Practice Address - Country:US
Practice Address - Phone:224-676-0450
Practice Address - Fax:224-676-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01633096OtherBCBS