Provider Demographics
NPI:1144703976
Name:MCINERNEY, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MCINERNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 BIRCH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2840
Mailing Address - Country:US
Mailing Address - Phone:847-447-3098
Mailing Address - Fax:312-312-9631
Practice Address - Street 1:2955 BIRCH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2840
Practice Address - Country:US
Practice Address - Phone:847-447-3098
Practice Address - Fax:312-312-9631
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist