Provider Demographics
NPI:1043602352
Name:HENDRY, SHERYLE (PTA)
Entity Type:Individual
Prefix:
First Name:SHERYLE
Middle Name:
Last Name:HENDRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 E 1700TH RD
Mailing Address - Street 2:
Mailing Address - City:BROCTON
Mailing Address - State:IL
Mailing Address - Zip Code:61917-8024
Mailing Address - Country:US
Mailing Address - Phone:217-385-2222
Mailing Address - Fax:
Practice Address - Street 1:5121 E 1700TH RD
Practice Address - Street 2:
Practice Address - City:BROCTON
Practice Address - State:IL
Practice Address - Zip Code:61917-8024
Practice Address - Country:US
Practice Address - Phone:217-385-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006856225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant