Provider Demographics
NPI:1831470707
Name:CASTOR, SHERRI L (MPT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:CASTOR
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:717 N 190TH PLZ STE 2000
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3913
Practice Address - Country:US
Practice Address - Phone:402-815-2061
Practice Address - Fax:402-815-2062
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025895900Medicaid
NE10025896100Medicaid
NE10026056700Medicaid
IA1831470707Medicaid
NE10025941700Medicaid
NE10026252200Medicaid
NE10025896000Medicaid
IA1831470707Medicaid