Sean Mark Labastida Superticioso, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070024159 Issued in IL

Practice address

1 S Virginia St
Crystal Lake, IL 60014-5828

Phone

(815) 356-9371

Fax

(815) 356-9428

NPI assigned

Apr 1, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crystal Lake Physical Therapy IncGroup PAC ID 1254636491, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crystal Lake Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Crystal Lake, IL
  • NPI 1326404682

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Aranem Incorporated

  dba Maxicare Physical Therapy & Wellness

  • Physical Therapist
  • Carpentersville, IL
  • NPI 1063963908
  Medicare reassignment NPD
• Comprehensive Therapeutics LTD

  • Physical Therapist
  • North Riverside, IL
  • NPI 1699094102
  Medicare reassignment NPD
• Comprehensive Therapeutics LTD

  • Physical Therapist
  • Lagrange, GA
  • NPI 1881458354
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1497217350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145828",
            "telephone_number": "815-356-9371",
            "fax_number": "815-356-9428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145828",
            "telephone_number": "815-356-9371",
            "fax_number": "815-356-9428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERTICIOSO",
        "first_name": "SEAN MARK",
        "middle_name": "LABASTIDA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-01",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070024159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Sullivan, NP
• Timothy P Sullivan, D.D.S.
• Ann Marie Sumpter, L.C.S.W.
• Xuefan Sun, PHARMD
• Superior Health and Wellness of Crystal Lake, LTD.
• Nicolette Surico, LCPC
• Richard Joseph Surowiak, O.D.
• Susan J. Coe, PHD., P.C.
• Hunter Sussky
• Sharon Ruth Swan, L.P.N.

• Physical Therapist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.