Provider Demographics
NPI:1235687351
Name:BELTRAN, SHERYL MAE (PT)
Entity Type:Individual
Prefix:
First Name:SHERYL MAE
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5657 WHISPERING WAY
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4348
Mailing Address - Country:US
Mailing Address - Phone:815-914-5520
Mailing Address - Fax:
Practice Address - Street 1:5657 WHISPERING WAY
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4348
Practice Address - Country:US
Practice Address - Phone:815-914-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist