Provider Demographics
NPI:1043524564
Name:MORESCO, SHERYL L (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:L
Last Name:MORESCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHERYL
Other - Middle Name:L
Other - Last Name:NABOURS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2306
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7306
Mailing Address - Country:US
Mailing Address - Phone:817-594-9200
Mailing Address - Fax:817-594-9202
Practice Address - Street 1:879 EUREKA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5807
Practice Address - Country:US
Practice Address - Phone:817-594-9200
Practice Address - Fax:817-594-9202
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist