Provider Demographics
NPI:1831739895
Name:SACCOLITI, SHERRY IONE (PT, DPT, MA)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:IONE
Last Name:SACCOLITI
Suffix:
Gender:F
Credentials:PT, DPT, MA
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:IONE
Other - Last Name:BACKUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT, MA
Mailing Address - Street 1:163 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1929
Mailing Address - Country:US
Mailing Address - Phone:201-906-1779
Mailing Address - Fax:
Practice Address - Street 1:510 E 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4010
Practice Address - Country:US
Practice Address - Phone:212-606-1659
Practice Address - Fax:212-774-7859
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic