Provider Demographics
NPI:1568687242
Name:WOLOWICE, SHERYL ANNE (MPT)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANNE
Last Name:WOLOWICE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6743
Mailing Address - Country:US
Mailing Address - Phone:928-649-9726
Mailing Address - Fax:928-634-2079
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-649-9726
Practice Address - Fax:928-634-2079
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117740Medicare PIN