Provider Demographics
NPI:1073611158
Name:SPERRY, LINDA KAY (PT, CMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:SPERRY
Suffix:
Gender:F
Credentials:PT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0757
Mailing Address - Country:US
Mailing Address - Phone:702-346-1899
Mailing Address - Fax:702-346-8581
Practice Address - Street 1:1140 W. PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027
Practice Address - Country:US
Practice Address - Phone:702-346-1899
Practice Address - Fax:702-346-8581
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3039225100000X
NV3310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO650021308OtherRAILROAD MEDICARE
CO841591699002OtherROCKY MOUNTAIN HMO
COSP27819OtherBLUE CROSS
S46425Medicare UPIN
CO650021308OtherRAILROAD MEDICARE