Provider Demographics
NPI:1407604838
Name:SCHUBER, SHEENA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:MARIE
Last Name:SCHUBER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:MARIE
Other - Last Name:BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7830 WHITTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6722
Mailing Address - Country:US
Mailing Address - Phone:708-577-3781
Mailing Address - Fax:
Practice Address - Street 1:10511 EMILIE LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8875
Practice Address - Country:US
Practice Address - Phone:708-577-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006462225200000X
IL160006462225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant