Provider Demographics
NPI:1932469772
Name:SEGER, GERALD RAYMOND
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:RAYMOND
Last Name:SEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 N MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SCALES MOUND
Mailing Address - State:IL
Mailing Address - Zip Code:61075-9583
Mailing Address - Country:US
Mailing Address - Phone:815-845-2591
Mailing Address - Fax:
Practice Address - Street 1:4622 N MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:SCALES MOUND
Practice Address - State:IL
Practice Address - Zip Code:61075-9583
Practice Address - Country:US
Practice Address - Phone:815-845-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070,000934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist