Provider Demographics
NPI:1861826992
Name:DEDELL, SHERRY (DPT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:DEDELL
Suffix:
Gender:F
Credentials:DPT
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 4000
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-4000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:365 DILLON RIDGE RD
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-6342
Practice Address - Country:US
Practice Address - Phone:970-262-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036630-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist