1770915159 NPI number — MS. BROOKE KRISTIN SEESENGOOD PT, DPT, CLT

Table of content: MS. BROOKE KRISTIN SEESENGOOD PT, DPT, CLT (NPI 1770915159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770915159 NPI number — MS. BROOKE KRISTIN SEESENGOOD PT, DPT, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEESENGOOD
Provider First Name:
BROOKE
Provider Middle Name:
KRISTIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
URFER
Provider Other First Name:
BROOKE
Provider Other Middle Name:
KRISTIN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, CLT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770915159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5760 N SHIPLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62450-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-302-1164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5760 N SHIPLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62450-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-302-1164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070.018769 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)