Provider Demographics
NPI:1104597962
Name:KISHEL, SEAN MATTHEW (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MATTHEW
Last Name:KISHEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23550 CENTER RIDGE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3655
Mailing Address - Country:US
Mailing Address - Phone:440-895-9770
Mailing Address - Fax:
Practice Address - Street 1:23550 CENTER RIDGE RD STE 105
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3655
Practice Address - Country:US
Practice Address - Phone:440-895-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1383821225100000X
NY047694225100000X
GAPT015996225100000X
COPTL.0018656225100000X
OHPT021378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist