Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070-019024 | IL |
Y | 225100000X | Physical Therapist | 5501017835 | MI |
N | 2251S0007X | Physical Therapist - Sports | PT016642 | OH |
NPI | 1235496027 |
---|---|
Provider Name | Sheena Long |
First Address | Westmont, IL 60559-5548 |
Second Address | Ann Arbor, MI 48108-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 05/08/2020 |