Provider Demographics
NPI:1053774471
Name:VILLASIS, SHERYL (PT/DPT)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:VILLASIS
Suffix:
Gender:F
Credentials:PT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 FLINTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1883
Mailing Address - Country:US
Mailing Address - Phone:719-599-7328
Mailing Address - Fax:719-264-0227
Practice Address - Street 1:5820 FLINTRIDGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1883
Practice Address - Country:US
Practice Address - Phone:719-599-7328
Practice Address - Fax:719-264-0227
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2251500000XMedicaid