Healthcare Provider Details

I. General information

NPI: 1316089287
Provider Name (Legal Business Name): SHERI PUEBLO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SIERRA PARK RD
MAMMOTH LAKES CA
93546-0660
US

IV. Provider business mailing address

PO BOX 660
MAMMOTH LAKES CA
93546-0660
US

V. Phone/Fax

Practice location:
  • Phone: 760-934-7302
  • Fax: 760-934-1779
Mailing address:
  • Phone: 760-934-7302
  • Fax: 760-934-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18024
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberPT18024
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT18024
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT18024
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT18024
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT18024
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT18024
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT18024
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT18024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: