Provider Demographics
NPI:1609856103
Name:TRASK, SHERYL L (PT)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:TRASK
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 1:5480 LAKE RD S
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9754
Mailing Address - Country:US
Mailing Address - Phone:585-637-8305
Mailing Address - Fax:585-637-9117
Practice Address - Street 1:5480 LAKE RD S
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-9754
Practice Address - Country:US
Practice Address - Phone:585-637-8305
Practice Address - Fax:585-637-9117
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010728-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01949724Medicaid
NYFA0525OtherPREFERRED CARE
NY6699699OtherGHI
NYP010010728OtherBLUE CROSS BLUE SHIELD
NM820882OtherEMPIRE
NY6699699OtherGHI