Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Sean Mark Labastida Superticioso, PT

Individual provider Physical Therapist · NPI 1497217350

Sean Mark Labastida Superticioso, PT is a Physical Therapist in Private Practice in Crystal Lake, Illinois. Qualified in 2017, 9 years ago. Practices with Crystal Lake Physical Therapy Inc, a 5-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
9
Licensed in
IL
In the registry since
2019
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

1 S Virginia St
Crystal Lake, IL 60014-5828
Phone: (815) 356-9371
Fax: (815) 356-9428
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 070024159 (IL)

Record details

NPI number1497217350
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedApril 1, 2019
Last updated in NPPESApril 1, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Crystal Lake Physical Therapy Inc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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