Provider Demographics
NPI:1386873248
Name:SHEA, JORI L (MPT)
Entity type:Individual
Prefix:
First Name:JORI
Middle Name:L
Last Name:SHEA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JORI
Other - Middle Name:L
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
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
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010526225100000X
WI11584-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6237004OtherMEDICARE
ILIL6238004OtherMEDICARE
WI859400060OtherMEDICARE
ILIL6697007OtherMEDICARE
WI1386873248Medicaid
IL539320003OtherMEDICARE