Healthcare Provider Details

I. General information

NPI: 1487840112
Provider Name (Legal Business Name): SHERRI LYN GOLEBIOWSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COMMERCE DR SUITE 112
GRAYSLAKE IL
60030-7807
US

IV. Provider business mailing address

15 COMMERCE DR SUITE 112
GRAYSLAKE IL
60030-7807
US

V. Phone/Fax

Practice location:
  • Phone: 847-223-0200
  • Fax: 847-245-8889
Mailing address:
  • Phone: 847-223-0200
  • Fax: 847-245-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: