Provider Demographics
NPI:1093988693
Name:LANDSTROM, SHERYL (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:
Last Name:LANDSTROM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:SHERYL
Other - Middle Name:
Other - Last Name:LUCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:32810 N 3100 EAST RD
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-8078
Mailing Address - Country:US
Mailing Address - Phone:815-584-1819
Mailing Address - Fax:
Practice Address - Street 1:32810 N 3100 EAST RD
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-8078
Practice Address - Country:US
Practice Address - Phone:815-584-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist