MEDICARE: SHERYL L TRASK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	010728-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	FA0525	OTHER	NY	PREFERRED CARE
3	6699699	OTHER	NY	GHI
4	P010010728	OTHER	NY	BLUE CROSS BLUE SHIELD
5	820882	OTHER	NM	EMPIRE

General Provider Information

NPI Number	:	1609856103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL L TRASK PT

Provider Business Mailing Address
First Line	:	5480 LAKE RD S
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-9754
Country	:	US
Telephone Number	:	585-637-8305
Fax Number	:	585-637-9117

Provider Business Practice Location Address
First Line	:	5480 LAKE RD S
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-9754
Country	:	US
Telephone Number	:	585-637-8305
Fax Number	:	585-637-9117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/02/2017

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