Provider Demographics
NPI:1508031345
Name:DEPAKAKIBO, SHERYL (PT,DPT)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:DEPAKAKIBO
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:#202
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3263
Mailing Address - Country:US
Mailing Address - Phone:847-268-0280
Mailing Address - Fax:847-268-0283
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:#202
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-268-0280
Practice Address - Fax:847-268-0283
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist