Provider Demographics
NPI:1215165097
Name:NORGAARD, SHEINA BURILLO (PT)
Entity type:Individual
Prefix:MS
First Name:SHEINA
Middle Name:BURILLO
Last Name:NORGAARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHEINA
Other - Middle Name:BURILLO
Other - Last Name:PIENCENAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:100 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2884
Mailing Address - Country:US
Mailing Address - Phone:646-943-3135
Mailing Address - Fax:618-488-6433
Practice Address - Street 1:100 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2884
Practice Address - Country:US
Practice Address - Phone:646-943-3135
Practice Address - Fax:618-488-6433
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UU0095314OtherPASSPORT
IL204-049-068OtherUSCIS