Basic Information
| Provider Information | |||||||||
| NPI: | 1003296997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASQUEZ | ||||||||
| FirstName: | SHERLEY | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 SWATARA RD | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179761232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709853160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 SWATARA RD | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179761232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709853160 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT017459 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.